COVID-19 and its impact on the cardiovascular system

Khawaja, Saud Ahmed; Mohan, Poornima; Jabbour, Richard; Bampouri, Theodora; Bowsher, Gemma; Hassan, Ahmed M M; Huq, Farhan; Baghdasaryan, Lilit; Wang, Brian; Sethi, Amarjit; Sen, Sayan; Petraco, Ricardo; Ruparelia, Neil; Nijjer, Sukhjinder; Malik, Iqbal; Foale, Rodney; Bellamy, Michael; Kooner, Jaspal; Rana, Bushra; Cole, Graham; Sutaria, Nilesh; Kanaganayagam, Gajen; Nihoyannopoulos, Petros; Fox, Kevin; Plymen, Carla; Pabari, Punam; Howard, Luke; Davies, Rachel; Haji, Gulammehdi; Lo Giudice, Francesco; Kanagaratnam, Prapa; Anderson, Jon; Chukwuemeka, Andrew; Khamis, Ramzi; Varnava, Amanda; Baker, Christopher S R; Francis, Darrel Parthipan; Asaria, Perviz; Al-Lamee, Rasha; Mikhail, Ghada W

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.