Acute Myocardial Injury of Patients with Coronavirus Disease 2019

Huayan Xu; Keke Hou; Hong Xu; Zhenlin Li; Huizhu Chen; Na Zhang; Rong Xu; Hang Fu; Ran Sun; Lingyi Wen; Linjun Xie; Hui Liu; Kun Zhang; Joseph B Selvanayagam; Chuan Fu; Shihua Zhao; Zhigang Yang; Ming Yang; Yingkun Guo

The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.05.20031591 doi: medRxiv preprint study who died all had extremely elevated cardiac marker levels, acute heart failure may play a fatal role in multiple organ dysfunction and accelerate death. However, further evidence is urgently needed to assess the mechanism of cardiac damage in large-sample autopsy or biopsy studies. Previous studies have indicated that SARS-CoV can mediate MI and damage associated with the downregulation of the myocardial angiotensin-converting enzyme 2 system; this may be responsible for the myocardial dysfunction and adverse cardiac outcomes in patients with SARS, which has also been detected in COVID-19 patients. [19] [20] [21] [22] Until now, the pathophysiology of SARS-CoV or MERS-CoV has not been completely understood. Although full-genome sequencing and phylogenic analysis has shown that SARS-CoV-2 is similar to SARS-CoV or MERS-CoV, the pathophysiological mechanism of cardiac infection or damage caused by SARS-CoV-2 needs to be further validated in future studies. 23 In our study, AMI usually occurred in COVID-19 patients with old age, underlying comorbidities, severe or critically severe NCP, and ARDS. Among 44,672 patients with confirmed COVID-19, as reported in the China CDC Weekly on Feb 11, 2020, approximately 31.2% patients were aged >60 years. The overall case fatality rate was 2.3% (1,023 deaths); more importantly, the majority (81%) of deaths occurred in patients aged ≥ 60 years or in those with underlying medical conditions. 24 Similarly, in our study, all the six AMI patients were aged >60 years and had one or more underlying conditions, including diabetes, hypertension, COPD, and cardiovascular diseases. As described in a retrospective study of 1,099 laboratory-confirmed cases, All rights reserved. No reuse allowed without permission.