Clinical Characteristics and Risk Factors of Cardiac Involvement in COVID-19

Huayan Xu, Keke Hou, Rong Xu, Zhenlin Li, Hang Fu, Lingyi Wen, Linjun Xie, Hui Liu, Joseph B. Selvanayagam, Na Zhang, Zhigang Yang, Ming Yang, Yingkun Guo

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Background Increasing studies demonstrated that the cardiac involvements are related to coronavirus disease 2019 (COVID-19). Thus, we investigated the clinical characteristics of patients with COVID-19 and further determined the risk factors for cardiac involvement in them. Methods and Results We analyzed data from 102 consecutive laboratory-confirmed and hospitalized patients with COVID-19 (52 women aged 19-87 years). Epidemiologic and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury biomarkers), echocardiography, electrocardiography, chest imaging findings, management methods, and clinical outcomes were collected. Patients were divided into acute cardiac injury, with and without cardiac marker abnormities groups according to different level of cardiac markers. In this research, cardiac involvement was found in 72 of the 102 (70.6%) patients: tachycardia (n=20), electrocardiography abnormalities (n=23), echocardiography abnormalities (n=59), elevated myocardial enzymes (n=55), and acute cardiac injury (n=9). Eight patients with acute cardiac injury were aged >60 years; seven of them had ≥2 underlying comorbidities (hypertension, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and chronic kidney disease). Novel coronavirus pneumonia was much more severe in the patients with acute cardiac injury than in patients with nondefinite acute cardiac injury (P<0.001). Multivariate analyses showed that CRP (C-reactive protein) levels, old age, novel coronavirus pneumonia severity, and underlying comorbidities were the risk factors for cardiac abnormalities in patients with COVID-19. Conclusions Cardiac involvements are common in patients with COVID-19. Elevated CRP levels, old age, underlying comorbidities, and novel coronavirus pneumonia severity are the main risk factors for cardiac involvement in patients with COVID-19. More attention should be given to cardiovascular protection during COVID-19 treatment for mortality reduction. Registration URL:; Unique identifier: ChiCTR2000029955.

Original languageEnglish
Article numbere016807
Number of pages11
JournalJournal of the American Heart Association
Issue number18
Publication statusPublished - 15 Sept 2020

Bibliographical note

his is an open access article under the terms of the Creative Commons Attribution-Non Commercial-No Derivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made


  • acute cardiac injury
  • cardiac involvement
  • COVID‐19
  • risk factor


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