COVID-19 and its impact on the cardiovascular system
Saud Khawaja, Poornima Mohan, Richard J. Jabbour, Theodora Bampouri, Gemma Bowsher, Ahmed Medhat Hassan, Farhan Huq, Lilit Baghdasaryan, Brian Wang, Amarjit Sethi, Sayan Sen, Ricardo Petraco, Neil Ruparelia, Sukhjinder Nijjer, Iqbal Malik, Rodney A. Foale, Michael Bellamy, Jaspal S. Kooner, Bushra S. Rana, Graham D. Cole, Nilesh Sutaria, Gajen Kanaganayagam, Petros Nihoyannopoulos, Kevin Fox, Carla M. Plymen, Punam Pabari, Luke Howard, Rachel Davies, Gulammehdi Haji, Francesco Lo Giudice, Prapa Kanagaratnam, Jon E. Anderson, Andrew Chukwuemeka, Ramzi Khamis, Amanda Varnava, Christopher Baker, Darrel Parthipan Francis, Perviz Asaria, Rasha Al‐Lamee, Ghada Mikhail
Abstract
OBJECTIVES: The clinical impact of SARS-CoV-2 has varied across countries with varying cardiovascular manifestations. We review the cardiac presentations, in-hospital outcomes and development of cardiovascular complications in the initial cohort of SARS-CoV-2 positive patients at Imperial College Healthcare National Health Service Trust, UK. METHODS: We retrospectively analysed 498 COVID-19 positive adult admissions to our institute from 7 March to 7 April 2020. Patient data were collected for baseline demographics, comorbidities and in-hospital outcomes, especially relating to cardiovascular intervention. RESULTS: Mean age was 67.4±16.1 years and 62.2% (n=310) were male. 64.1% (n=319) of our cohort had underlying cardiovascular disease (CVD) with 53.4% (n=266) having hypertension. 43.2%(n=215) developed acute myocardial injury. Mortality was significantly increased in those patients with myocardial injury (47.4% vs 18.4%, p<0.001). Only four COVID-19 patients had invasive coronary angiography, two underwent percutaneous coronary intervention and one required a permanent pacemaker implantation. 7.0% (n=35) of patients had an inpatient echocardiogram. Acute myocardial injury (OR 2.39, 95% CI 1.31 to 4.40, p=0.005) and history of hypertension (OR 1.88, 95% CI 1.01 to 3.55, p=0.049) approximately doubled the odds of in-hospital mortality in patients admitted with COVID-19 after other variables had been controlled for. CONCLUSION: Hypertension, pre-existing CVD and acute myocardial injury were associated with increased in-hospital mortality in our cohort of COVID-19 patients. However, only a low number of patients required invasive cardiac intervention.