Cardiovascular Changes in Patients With COVID-19 From Wuhan, China

Limin Song; Shuai Zhao; Li Wang; Kai Yang; Weimin Xiao; Sean P Clifford; Jiapeng Huang; Xiangdong Chen

doi:10.3389/fcvm.2020.00150

Cardiovascular Changes in Patients With COVID-19 From Wuhan, China

Front Cardiovasc Med. 2020 Sep 2:7:150. doi: 10.3389/fcvm.2020.00150. eCollection 2020.

Authors

Limin Song¹, Shuai Zhao¹, Li Wang¹, Kai Yang¹, Weimin Xiao¹, Sean P Clifford², Jiapeng Huang², Xiangdong Chen¹

Affiliations

¹ Department of Anesthesiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
² Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, United States.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is rapidly spreading and resulting in a significant loss of life around the world. However, specific information characterizing cardiovascular changes in COVID-19 is limited. Methods: In this single-centered, observational study, we enrolled 38 adult patients with COVID-19 from February 10 to March 13, 2020. Clinical records, laboratory findings, echocardiography, and electrocardiogram reports were collected and analyzed. Results: Of the 38 patients enrolled, the median age was 68 years [interquartile range (IQR), 55-74] with a slight female majority (21, 55.3%). Nineteen (50.0%) patients had hypertension. Seven (33.3%) had ST-T segment and T wave changes, and four (19%) had sinus tachycardia. Twenty (52.6%) had an increase in ascending aorta (AAO) diameter, 22 (57.9%) had an increase in left atrium (LA) size, and 28 (73.7%) presented with ventricular diastolic dysfunction. Correlation analysis showed that the AAO diameter was significantly associated with C-reactive protein (r = 0.4313) and creatine kinase-MB (r = 0.0414). LA enlargement was significantly associated with C-reactive protein (r = 0.4377), brain natriuretic peptide (r = 0.7612), creatine kinase-MB (r = 0.4940), and aspartate aminotransferase (r = 0.2947). Lymphocyte count was negatively associated with the AAO diameter (r = -0.5329) and LA enlargement (r = -0.3894). Conclusions: Hypertension was a common comorbidity among hospitalized patients with COVID-19, and cardiac injury was the most common complication. Changes in cardiac structure and function manifested mainly in the left heart and AAO in these patients. Abnormal AAO and LA size were found to be associated with severe inflammation and cardiac injury. Alternatively, ascending aortic dilation and LA enlargement might be present before infection but characterized the patient at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Keywords: abnormal ascending aorta; abnormal left atrium size; cardiac injury; coronavirus disease 2019 (COVID-19); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).