PDF(Pubmed)
Abstract：
Cardiac complications in patients with COVID-19 have been described in the literature with an important impact on outcome. The primary objective of our systematic review was to describe the kind of cardiac complications observed in COVID-19 patients and to identify potential predictors of cardiovascular events. The secondary aim was to analyze the effect of cardiac complications on outcome.We performed this systematic review according to PRISMA guidelines using several databases for studies evaluating the type of cardiac complications and risk factors in COVID-19 patients. We also calculated the risk ratio (RR) and 95% CI. A random-effects model was applied to analyze the data. The heterogeneity of the retrieved trials was evaluated through the I2 statistic. Our systematic review included 49 studies. Acute cardiac injury was evaluated in 20 articles. Heart failure and cardiogenic shock were reported in 10 articles. Myocardial infarction was evaluated in seven of the papers retrieved. Takotsubo, myocarditis, and pericardial effusion were reported in six, twelve, and five articles, respectively. Arrhythmic complications were evaluated in thirteen studies. Right ventricular dysfunction was evaluated in six articles. We included 7 studies investigating 2115 patients in the meta-analysis. The RR was 0.20 (95% CI: 0.17 to 0.24; P < 0.00001, I2 = 0.75). Acute cardiac injury represented the prevalent cardiac complications observed in COVID-19 patients (from 20 to 45% of the patients). Patients with acute cardiac injury seemed to be significantly older, with comorbidities, more likely to develop complications, and with higher mortality rates. Acute cardiac injury was found to be an independent risk factor for severe forms of SARS-CoV-2 infection and an independent predictor of mortality. Due to the scarce evidence, it was not possible to draw any conclusion regarding Takotsubo, myocarditis, pleural effusion, and right ventricular dysfunction in COVID-19 patients. Noteworthy, possible arrhythmic alterations (incidence rate of arrhythmia from 3 to 60%) in COVID-19 patients have to be taken into account for the possible complications and the consequent hemodynamic instabilities. Hypertension seemed to represent the most common comorbidities in COVID-19 patients (from 30 to 59.8%). The prevalence of cardiovascular disease (CVD) was high in this group of patients (up to 57%), with coronary artery disease in around 10% of the cases. In the majority of the studies retrieved, patients with CVD had a higher prevalence of severe form, ICU admission, and higher mortality rates.
摘要：
文献中已经描述了COVID-19患者的心脏并发症，对预后有重要影响。我们系统评价的主要目的是描述在COVID-19患者中观察到的心脏并发症类型，并确定心血管事件的潜在预测因子。次要目的是分析心脏并发症对预后的影响。我们根据PRISMA指南，使用多个数据库对COVID-19患者的心脏并发症类型和危险因素进行了系统评价。我们还计算了风险比(RR)和95%CI。采用随机效应模型对数据进行分析。通过I2统计量评估检索到的试验的异质性。我们的系统评价包括49项研究。在20篇文章中评估了急性心脏损伤。10篇文献报道了心力衰竭和心源性休克。在检索到的七篇论文中评估了心肌梗塞。Takotsubo,心肌炎,和心包积液报告有六个，十二,五篇文章,分别。在13项研究中评估了心律失常并发症。在六篇文章中评估了右心室功能障碍。在荟萃分析中，我们纳入了7项研究，调查了2115名患者。RR为0.20（95%CI：0.17~0.24；P<0.00001，I2=0.75）。急性心脏损伤是在COVID-19患者中观察到的普遍心脏并发症(占患者的20%至45%)。急性心脏损伤的患者似乎明显年龄较大，有合并症，更有可能出现并发症，和更高的死亡率。发现急性心脏损伤是严重SARS-CoV-2感染的独立危险因素，也是死亡率的独立预测因素。由于缺乏证据,无法得出任何关于Takotsubo的结论，心肌炎,胸腔积液,COVID-19患者的右心室功能障碍。值得注意的是,COVID-19患者可能的心律失常改变(心律失常的发生率从3%到60%)必须考虑到可能的并发症和随之而来的血液动力学不稳定性。高血压似乎是COVID-19患者中最常见的合并症（从30％到59.8％）。心血管疾病（CVD）的患病率在这组患者中很高（高达57％），约10%的病例患有冠状动脉疾病。在检索到的大多数研究中，CVD患者的严重形式患病率较高，入住ICU,和更高的死亡率。
