A review of cardiac manifestations and predictors of outcome in patients with COVID - 19.
Ajay Kumar Mishra, Kamal Kant Sahu, Anu Anna George and 1 others
PMID 32593418WHAT IT FOUND
In patients with COVID-19, elevated or rising high-sensitivity troponin was repeatedly associated with cardiac injury, severe illness, ICU admission and mortality.
Troponin trends and QTc risk from hydroxychloroquine or azithromycin need monitoring.
Key findings
01Myocardial involvement mostly appeared as acute cardiac injury in around 8 to 12% of patients.
02Elevated or rising high-sensitivity troponin, above the 99th percentile when used to define injury, was associated with ICU admission and mortality.
03Hydroxychloroquine and azithromycin raised concerns about QTc prolongation and arrhythmia risk, while statins, ARBs and ACE inhibitors awaited further evidence.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a trial or systematic review, so it cannot show that any treatment works. The authors did not describe how they selected the studies they reviewed. Most cited studies lacked baseline and post-discharge ECG or echocardiography details. Cardiac injury was largely defined by biomarkers, and ischemic injury was not supported by evidence. Data were limited for patients with cardiac transplants, congenital heart disease or pregnancy.
Declared interests
The authors reported no funding and no conflicts of interest.
The easy way to misread this
Do not read this review as proof that troponin testing should change treatment or that hydroxychloroquine, azithromycin, steroids or immunoglobulin improve outcomes. It reports associations and inconsistent case-level treatment results, and says mortality benefit of agents is not established in clinical trials.