Cardiac injury, also referred to as myocardial injury, occurs when there is damage to the heart muscle, and such damage can occur when blood flow to the heart is reduced — which is what causes a heart attack.
The new study, conducted from January to February, included data on 416 adults who were confirmed to have Covid-19 and were hospitalized at Renmin Hospital of Wuhan University in China.
The data also revealed that the death rate was higher among patients with cardiac injury versus those without: 42 of the patients with cardiac injury, or 51.2%, died versus 15 of those without, or 4.5%.
“We know that cardiac damage is a marker for more mortality,” Michos said. “This study clearly showed that even after you account for age and pre-existing cardiovascular disease, there was a still four-fold increased risk of dying. That’s really important.”
The new study had some limitations, including that the findings are based on observational data, and more research is needed to determine whether similar findings would emerge among a larger and more diverse group of Covid-19 patients.
Though the study showed cardiac injury is a common condition among patients hospitalized with Covid-19, it did not indicate whether Covid-19 directly causes cardiac injury. The mechanism of cardiac injury, or the process in which it occurs, among the patients with Covid-19 remains uncertain, and more evidence is needed to demonstrate whether Covid-19 directly injures the heart, the authors said.
“We need to figure out the mechanism of why do people with evidence of cardiac injury have higher morbidity or mortality? Is it related to the fact that they have underlying conditions that make them more susceptible to dying? Is it a marker of individuals that have a more robust immune response that is leading to heart damage?” said Michos of Johns Hopkins.
This and other studies suggest that those with elevated troponin, which measures cardiac injury, seem to be at a greater risk than when the elevation of other types of markers are present, such as inflammatory markers, Michos said.
The researchers also offered some ideas, writing in the study that people with preexisting cardiovascular diseases might be more susceptible to heart injury induced by Covid-19.
“Approximately 30% and 60% of patients with cardiac injury in the present study had a history of coronary heart disease and hypertension, respectively, which were significantly more prevalent than in those without cardiac injury,” the researchers wrote in the study.
Also, acute inflammatory responses due to an infection can lead to reduced blood flow in patients with preexisting cardiovascular diseases, the researchers noted. They wrote that “based on these lines of evidence, we hypothesize that an intense inflammatory response superimposed on preexisting cardiovascular disease may precipitate cardiac injury.”
A ‘potentially important long-term issue’
When it comes to the public health impacts of Covid-19 and cardiac injury, the study suggests that “two key take-aways are that it’s an important marker of those at high-risk for mortality as a consequence of Covid-19 infection and it may be an indicator of future risks associated with the cardiovascular injury from this infection, even if you recover,” Gump said.
“Even though they’re not dying from that cardiac injury, something about that biomarker is providing some prognostic value beyond other risk factors that were controlled, so it could still be important in terms of identifying high-risk patients that enter the hospital with Covid-19,” Gump said.
“The other key here is the potentially important long-term issue,” he said. “Many patients who pull through may still have cardiac injury and associated long-term cardiovascular issues as a consequence of Covid-19 infection.”
They noted in the editorial that so far there have been only scarce data with respect to cardiovascular complications of Covid-19.
“To date, many patients with COVID-19 are still hospitalized in China and other countries, such as Italy and Iran. Therefore, continued observations of the cardiovascular complications of the disease are needed. In addition, further assessment is needed to identify risk factors for poor prognosis,” Yang and Jin wrote. “Emerging as an acute infectious disease, COVID-19 may become a chronic epidemic similar to influenza because of genetic recombination. Therefore, we should be ready for the reemergence of COVID-19 or other coronaviruses.”
CNN’s Gina Yu contributed to this report.