Abstract:
Background: Coronavirus disease 2019 (COVID-19), commonly affects the lungs, but
the involvement of other organs, particularly the heart, is highly prevalent as has been
reported in several studies. The overall aim of this review was to provide an in-depth
description of the available literature related to the cardiac system and COVID-19
infection. It focuses on type and the frequency of cardiac manifestations, clinical
parameters and cardiac biomarkers that support the prognosis of COVID-19 patients,
and the cardiac adverse events and outcomes related to pharmacotherapy.
Methods: A scoping review was conducted searching Embase, PubMed, Epistomonikos,
Medrxiv, BioRxiv databases, up to November 2020, for systematic reviews relevant to
cardiac manifestations in adult COVID-19 patients. Relevant articles were screened
and extracted to summarize key outcomes and findings.
Results: A total of 63 systematic reviews met the inclusion criteria. The overall
frequency of acute cardiac injury ranged from 15% to 33% in the reporting studies. The
main cardiac complications were arrhythmias (3.1% to 6.9% in non-severe patients,
33.0% to 48.0% in severe disease), acute coronary syndromes (6% to 33% in severe
disease), and myocarditis. Most studies found no association with the use of Reninangiotensin-aldosterone system inhibitors (RAASI) with COVID-19 outcomes such as
susceptibility to infection, hospitalization, severity, and mortality.
Conclusion: This study provided an overview of the several cardiac complications
associated with Covid-19. Cardiac injury, arrhythmias, myocarditis, cardiac failure, and
acute coronary syndrome, are prevalent and clinically significant and associated with
COVID-19 disease severity and mortality. Other studies are needed to clearly identify
what is the part of viral heart infection and what is the part of cardiac injury secondary
to acute respiratory failure and inflammation. In the therapeutic field, these systematic
reviews gave heterogenous results. This underlines the importance of randomized
trials to determine the right therapeutic approach.
