United Kingdom

Coronavirus patients with heart damage are up to 11 times more likely to die than those without it

Cardiac ultrasounds have revealed how prevalent heart damage is among severely ill coronavirus patients, a new study suggests. 

Researchers found people hospitalized with COVID-19 were more likely to have injuries to the heart such as dysfunction of the ventricles or extra fluid around the organ from these ultrasounds, which are known as echocardiograms.

What's more, such abnormalities were linked with a more than 11 times higher risk of death among hospitalized patients. 

The team, from The Mount Sinai Hospital, says the findings may help doctors better understand how heart injury occurs so they can more quickly identify and treat patients at risk. 

Overall, hospitalized coronavirus patients with myocardial injury were nine times more likely to die at 27.5% compared to 3% of those without injury

Those that had abnormalities were more than 11 times more likely to die with 34.8% passing away in comparison with 3%

'Early detection of structural abnormalities may dictate more appropriate treatments, including anticoagulation and other approaches for hospitalized and post-hospitalized patients,' said co-author Dr Valentin Fuster, director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital. 

For the study, published in Journal of the American College of Cardiology, the team looked at 305 adult patients with COVID-19 admitted to four New York City hospitals within the Mount Sinai Health System and two hospitals in Milan, Italy.

They examined transthoracic echocardiographic (TTE) and electrocardiographic (ECG) scans performed between March and May 2020.  

More than 60 percent had evidence of myocardial injury, usually identified by high levels of a type of protein called cardiac troponin that are released when damage occurs.

About 38 percent of them had heart damage at the time of hospitalization admission and nearly one-quarter developed myocardial injury during hospitalization.  

Of the abnormalities that wee seen, 26.3 percent had right ventricular dysfunction, which is then the ventricle is unable to pump oxygen-poor blood the lungs.

This can lead to a pulmonary embolism, which occurs when there is a blockage in one of the pulmonary arteries in the lungs, or  severe respiratory failure), 

Nearly 24 percent had regional left ventricular wall motion abnormalities, meaning this chamber cannot contract properly, and which can be associated with heart attacks.

Results showed 18.4 percent had diffuse left ventricular dysfunction. which is when the chamber cannot pump oxygen-rich blood to the body, and is linked to heart failure.

About 13.2 percent had grade II or III diastolic dysfunction, which leads to stiffer cardiac chambers, and 7.2 percent had pericardial effusions, which occurs when extra fluid builds up around the heart and causes abnormal pumping.

Researchers also compared mortality among patients who had heart damage to those without.

Patients with myocardial injury were nine times more likely to die with 27.5 percent dying compared to three percent of those without injury.

Next, they compared coronavirus patients with no injury to those with injury and no abnormalities - just high troponin levels - as well those with injury and abnormalities.

Patients with high troponin levels were nearly six times more likely to die with 17.6 percent passing away.

Those with high levels and abnormalities, such as ventricle dysfunction, were more than 11 times more likely to die with 34.8 percent dying.  

'Our study shows that an echocardiogram performed with appropriate personal protection considerations is a useful and important tool in early identification of patients at greater risk for COVID-19-related cardiac injury, who may benefit from a more aggressive therapeutic approach earlier in their hospitalization,' said corresponding author Dr Martin Goldman, a professor of cardiology at the Icahn School of Medicine at Mount Sinai. 

'Additionally, because this is a new disease with lingering symptoms, we plan on following these patients closely using imaging to evaluate the evolution and hopefully resolution of these cardiac issues.' 

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