Editorial
Austin J Cardiovasc Dis Atherosclerosis. 2022; 9(1): 1050.
Prevalence and Outcomes of Cardiovascular Diseases in Patients with COVID-19 Stratified by Myocardial Injury: A Research Letter
Patel G1*, Vasavada A2, Reddy S3, Adak S4, Jain S5, Araya M6, Hassen G7, Regassa H8, Korsapati HR9, Korsapati AR10, Chand M9, Mukesh S11 and Korsapati S12
1Mercy Health Internal Medicine Residency, Javon Bea Hospital, Rockford, IL, USA
2MP Shah Medical College, Jamnagar, Gujarat, India
3Marian University, Indianapolis, IN
4MVJ Medical College & Research Hospital, Karnataka, India
5Medical College and Hospital, Kolkata, India
6Northside Gwinnett Hospital, Lawrenceville, GA
7Addis Ababa University, Ethiopia, University of Parma, Italy
8St. Paul’s Hospital Millennium Medical College, Gulele Sub-City, Ethiopia
9Mayo Clinic Health System, Mankato, MN
10University of Buckingham Medical School, Buckingham, UK
11Liaquat University of Medical and Health Science, Jamshoro, Pakistan
12SUNY Upstate Medical University, NY, USA
*Corresponding author: Ghanshyam Patel, Mercyhealth Internal Medicine Residency, Javon Bea Hospital, Rockford, Italy
Received: September 09, 2022; Accepted: September 23, 2022; Published: September 30, 2022
Editorial
A higher prevalence of cardiovascular diseases among COVID-19 with positive troponin levels was initially observed in China beginning of the pandemic era. We are trying to add to the material available with demographics and prevalence of cardiovascular disease among COVID-19 positives. SARS-CoV-2 is mainly a respiratory disease, but it can involve a heart with direct virulence through ACE-2, exaggerated inflammatory reaction, micro thrombosis, and endothelial injury [1]. We conducted a retrospective analysis to determine cardiovascular disease prevalence among these populations stratified by troponin levels. Cardiovascular diseases led to an increase in the rate of morbidity and mortality among COVID-19 patients. The viral infection in severe cases causes cytokine storm and hypercoagulability that manifests in various acute cardiovascular events like myocardial infarction, heart failure, and myocarditis or thrombotic events like pulmonary embolism and DIC [2]. There is also a high incidence of arrhythmia observed in cases with COVID-19 likely because of viral infection, QT-prolonging drugs like azithromycin, lopinavir, etc. The overall burden of cardiovascular diseases, demographics, and comorbidities in COVID-19 patients has been described in the literature but no causal relationship between them has been explored [3]. Also, there is little evidence regarding the characteristics of patients with myocardial injury [4]. Hence, further evidence on the subject can aid better evidence-based decisions on the prevention of acute cardiac events.
A retrospective observational study was conducted of patients with a clinical diagnosis of COVID-19 from January 2020 to December 2021 in a large community health service. Patients were included if they had a laboratory or nasal swab confirmed SARSCoV- 2 infection. Myocardial injury was defined as high-sensitive troponin T levels 99th percentile above the upper limit of normal for respective biological sex (22ng/ml for female; 14ng/ml for male). The primary outcome was to find out prevalence of cardiovascular disease among COVID-19 patients stratified by troponin level. Descriptive analyses were performed by troponin level divided into positive and negative. We evaluated demographic, baseline characteristics, and medical history of cardiovascular diseases. The categorical variables are reported as total count and percentage with their p-value based on the chi-square test.
A total of 13560 (45.3% Male, 21.5% aged >65 years) patients with COVID-19 were included, out of which 411 (3%) had a myocardial injury. Patients with myocardial injury were older (75.9% >65 years) and had higher cardiovascular-related comorbidities when compared with those without. The male and females were equally distributed (49.4% vs 45.2%, 50.6% vs 54.8%; Male and Female respectively). The population in this study was predominantly white (85.2% vs 86.4%) and non-Hispanics (92.2% vs 85.2%).The overall cardiovascular diseases and cardiovascular risk factors were markedly higher in the myocardial injury group. Hypertension and Diabetes were more prevalent among Troponin positive patients compared to those without. Troponin positive group had higher dyslipidemia, Myocardial Infarction (MI), unstable angina, coronary artery disease, cardiomyopathy, heart failure, arrhythmias, stroke, and Peripheral Arterial Disease (PAD). Hospitalization was higher in troponinpositive patients compared to those in troponin negative group (75.9% vs 10%). Length of stay and use of mechanical ventilation was higher in troponin-positive patients. The mortality among troponinpositive strata was 19.7% versus 1.6% in troponin-negative strata.
Characteristics
Overall population with Covid-19
Troponin positive (%)
Troponin negative (%)
P value
Total
13560
411
13149
Age
Mean (SD)
49 (18)
74 (13)
48 (18)
<0.01
Median (IQR)
49 (34,62)
75 (65, 84)
48 (34,61)
<0.01
18-49
6856
21 (5.1)
6835 (52)
<0.05
50-64
3792
78 (19)
3714 (28.3)
<0.05
>65
2912
312 (75.9)
2600 (19.8)
<0.05
Sex
Male
6142
203 (49.4)
5939 (45.2)
<0.01
Female
7417
208 (50.6)
7209 (54.8)
<0.01
Race
White
11705
350 (85.2)
11355 (86.4)
<0.01
Black Or AA
988
44 (10.7)
944 (7.2)
<0.09
Asian
111
2 (0.5)
109 (0.8)
<0.45
Multiracial
341
8 (1.9)
333 (2.5)
<0.65
Ethnicity
Non-Hispanic
11582
379 (92.2)
11203 (85.2)
<0.05
Hispanic
2842
28 (6.8)
1814 (13.8)
<0.79
Hypertension
4721
324 (78.8)
4397 (33.4)
<0.05
Diabetes
5261
336 (81.8)
4925 (37.5)
<0.05
Dyslipidemia
4987
290 (70.6)
4697 (35.7)
<0.05
MI
275
46 (11.2)
229 (1.8)
<0.28
Unstable angina
130
21 (5.1)
109 (0.8)
<0.35
Cardiomyopathy
304
63 (15.3)
241 (1.8)
<0.25
CAD
1018
159 (38.7)
859 (6.5)
<0.05
Angioplasty
3063
135 (32.8)
2928 (22.3)
<0.05
CABG
241
42 (10.2)
199 (1.5)
<0.21
HF
768
151 (36.7)
617 (4.7)
<0.05
Stroke
245
39 (9.5)
206 (1.6)
<0.09
PAD
428
63 (15.3)
365 (2.8)
<0.13
Arrhythmias
584
96 (23.4)
488 (3.7)
<0.15
Hospitalization
1632
312 (75.9)
1320 (10)
<0.01
LOS (Median days)
0 (0,0)
4 (1,7)
0 (0,0)
<0.05
Mechanical Ventilation
201
43 (10.5)
158 (1.2)
<0.09
Mortality
297
81 (19.7)
216 (1.6)
<0.07
Table 1: Demographic, clinical characteristics, prevalence, and outcomes of cardiovascular diseases of Covid-19 patients stratified by Troponin level.
In our study, we found the prevalence of cardiovascular diseases was much higher among Covid-19 patients with positive troponin levels. The main finding, confirming this study, is that the prevalence of cardiovascular diseases is significantly increased among patients with troponin positive and that this increase can be attributable to traditional risk factors. One previous study found 56.1% of prevalence of myocardial injury among hospitalized COVID-19 patients [5]. Further research may be needed to understand the pathophysiology of Covid-19 affecting cardiovascular diseases.
Authors’ Contributions
Conceptualization: Ghanshyam Patel, MD., Advait Vasavada, MBBS., Shilpa Reddy, DO., Shrestha Adak, MBBS., Shikha Jain, MBBS., Michael Araya, MD., Gashaw Hassen, MD., Henok Regassa, MD., Hariprasad Reddy Korsapati, MD, PhD., Aishwarya Reddy Korsapati, MD., Mool Chand, MD., Sindhu Mukesh, MD., Sunnyhith Korsapati, MD.
Writing: Ghanshyam Patel, MD., Advait Vasavada, MBBS., Shilpa Reddy, DO., Shrestha Adak, MBBS., Shikha Jain, MBBS., Michael Araya, MD., Gashaw Hassen, MD., Henok Regassa, MD., Hariprasad Reddy Korsapati, MD, PhD., Aishwarya Reddy Korsapati, MD., Mool Chand, MD., Sindhu Mukesh, MD., Sunnyhith Korsapati, MD.
Data-analysis: Ghanshyam Patel, MD., Advait Vasavada, MBBS., Shilpa Reddy, DO., Shrestha Adak, MBBS., Shikha Jain, MBBS., Michael Araya, MD., Gashaw Hassen, MD., Henok Regassa, MD., Hariprasad Reddy Korsapati, MD, PhD., Aishwarya Reddy Korsapati, MD., Mool Chand, MD., Sindhu Mukesh, MD., Sunnyhith Korsapati, MD.
Intellectual content: Ghanshyam Patel, MD., Hariprasad Reddy Korsapati, MD, PhD., Aishwarya Reddy Korsapati, MD., Mool Chand, MD., Sindhu Mukesh, MD.
Critical feedback and editing: G. Patel, Hariprasad Reddy Korsapati, MD, PhD Mool Chand, MD., Sindhu Mukesh, MD.
Article Guarantor: G. Patel.
IRB
IRB approval was obtained from the Mercyhealth corporation and the University of Illinois College of Medicine, Rockford.
Ethical Approval
Though this article does not contain any studies with direct involvement of human participants or animals performed by any of the authors, the ethical standards of the institutional and/or national research committee were following the 1975 Helsinki declaration.
Disclosure of Potential Conflict of Interest
Authors declare no conflict of interest.
Grant Support/Funding
The study had no internal or external funding source.
Data Availability Statement
The data presented in this study are available on request from the corresponding author.
Statement of Competing Interests
The authors report no competing interests.
References
- Patel G, Affinati M, Smith J, Baloch L Aqeel A. Mechanisms of cardiovascular injuries in SARS-CoV-2 infection. Int. J. Cardiol Cardiovasc. Dis. 2022, 2, 1–5. Available online: https://probiologists.com/Article/Mechanisms-ofcardiovascular- injuries-inSARS-CoV-2-infection.
- Parvu S, Müller K, Dahdal D, Cosmin I, Christodorescu R, et al. COVID-19 and cardiovascular manifestations. Eur Rev Med Pharmacol Sci. 2022; 26: 4509-4519.
- Sarfraz Z, Sarfraz A, Sarfraz M, Zia I, Ali MZ, et al. Cardiovascular Disease, Intensive Care, and Mortality in Coronavirus Disease 2019 Patients: A Meta- Analysis. Turk J Anaesthesiol Reanim. 2022; 50: S15-S21.
- Jaiswal V, Sarfraz Z, Sarfraz A, Mukherjee D, Batra N, et al. COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review. J Prim Care Community Health. 2021; 12: 21501327211056800.
- Patel G, Smith J, Baloch L, Affinati M, Vasavada A, Reddy S, et al. Prevalence, Predictors, and Outcomes of Myocardial Injury in Hospitalized COVID-19 Patients—An Observational Retrospective Study. Hearts. 2022; 3: 66–75.
Download PDF