新型冠状病毒肺炎相关心肌损伤：系统评价。

Cardiac Injury in COVID-19: A Systematic Review.

机构信息

Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran.

出版信息

Adv Exp Med Biol. 2021;1321:325-333. doi: 10.1007/978-3-030-59261-5_29.

DOI:10.1007/978-3-030-59261-5_29

PMID:33656737

Abstract

Coronavirus 2019 (COVID-19) is responsible for the current pandemic which has already resulted in considerable mortality worldwide. This systematic review was conducted to summarize the results of the published articles assessing the incidence of heart diseases in patients infected with COVID-19. The electronic databases Scopus, Web of Science, Pubmed, Science Direct, and ProQuest were used to search for potentially relevant articles. Articles published from Dec 2019 to April 2020 were included. All cross-sectional, retrospective or prospective observational cohort and case-control studies were selected which reported the incidence or prevalence of myocardial injury, myocardial infarction, or cardiovascular disease in patients with confirmed COVID-19 infection. Based on the inclusion criteria, 12 articles were selected. The incidence of cardiac injury was reported in 8 articles and 8 articles focused on the cardiovascular outcomes of COVID-19 infection. The incidence of new cardiac injury was reported to be 7.2-77% in live and dead patients, respectively. The results showed that patients with cardiac injury had worse outcomes including higher mortality than those without cardiac injury. The most common cardiac injury outcomes were shock and malignant arrhythmias. The most common radiographic findings in patients with cardiac injury were multiple mottling and ground-glass opacities in the lungs (64.6%). A significant number of patients with cardiac injury required noninvasive mechanical ventilation (46.3%) or invasive mechanical ventilation (22.0%). Acute respiratory distress syndrome was seen in 58.5%, acute kidney injury in 8.5%, electrolyte disturbances in 15.9%, hypoproteinemia in 13.4%, and coagulation disorders in 7.3% of patients with cardiac injuries. In addition, survival days were negatively correlated with cardiac troponin I levels (r = -0.42, 95%, p = 0.005). The results of this review showed that myocardial injury in patients with COVID 19 has a poor prognosis. Hence, cardiac investigation and management in these patients are crucial.

摘要

新型冠状病毒（COVID-19）引发了目前这场大流行，其已在全球范围内导致了相当高的死亡率。本系统评价旨在总结已发表文献中评估新型冠状病毒感染者心脏病发病情况的结果。我们使用 Scopus、Web of Science、Pubmed、Science Direct 和 ProQuest 电子数据库检索可能相关的文章。纳入 2019 年 12 月至 2020 年 4 月发表的文章。纳入报告了确诊新型冠状病毒感染者心肌损伤、心肌梗死或心血管疾病发病率或患病率的横断面、回顾性或前瞻性观察性队列研究和病例对照研究。根据纳入标准，选择了 12 篇文章。有 8 篇文章报道了心脏损伤的发生率，8 篇文章关注了新型冠状病毒感染的心血管结局。存活和死亡患者的新发心脏损伤发生率分别为 7.2%-77%。结果表明，心脏损伤患者的预后更差，死亡率高于无心脏损伤患者。最常见的心脏损伤结局为休克和恶性心律失常。心脏损伤患者最常见的影像学表现为肺部多发性斑片状和磨玻璃影（64.6%）。相当数量的心脏损伤患者需要无创性机械通气（46.3%）或有创性机械通气（22.0%）。急性呼吸窘迫综合征发生率为 58.5%，急性肾损伤发生率为 8.5%，电解质紊乱发生率为 15.9%，低蛋白血症发生率为 13.4%，凝血功能障碍发生率为 7.3%。此外，生存天数与肌钙蛋白 I 水平呈负相关（r=-0.42，95%，p=0.005）。本综述结果表明，新型冠状病毒感染者的心肌损伤预后不良。因此，对这些患者进行心脏检查和管理至关重要。