Publication Spotlight - Acute Cardiac Injury in Coronavirus Disease 2019 and Other Viral Infections—A Systematic Review and Meta-Analysis

June 21, 2021
What was done?

Understanding what causes organ injury during severe infectious diseases, such as COVID-19, is key to developing new treatments that can prevent death and disability.  In patients with COVID-19, the virus is able to enter and infect many of the body’s cells by binding the protein angiotensin-converting enzyme-2 (ACE2). In healthy individuals, ACE2 helps lower blood pressure and reduce inflammation by breaking down angiotensin II, which is the protein responsible for these activities. In patients with COVID-19, the virus binds ACE2 and prevents it from breaking down angiotensin II, which likely contributes to organ injury, including heart injury.  However, the frequency of heart injury as a result of COVID-19 is unknown.

How was this study done?

Here, the authors reviewed existing papers and scientific reports to compare the rates of heart injury between two different groups of patients with respiratory infections. One group of patients were diagnosed with pulmonary infections caused by viruses that bind to and prevent ACE2 from functioning, including SARS-CoV-2. The other group of patients were diagnosed with pulmonary infections that do not bind to ACE2. They also looked at rates of heart injury just in patients with COVID-19.  

What were the key findings?

Heart injury occurred in half of critically-ill COVID-19 patients, and the risk of experiencing heart injury is approximately one in five. Overall, critically-ill patients who suffer from a virus that infects the lungs and inhibits ACE2 had higher rates of heart injury (31% of patients) compared to critically-ill patients with other viral infections (12% of patients). The results suggest that any infection caused by a virus that binds ACE2 may lead to higher rates of heart injury. Further research is needed to confirm that high rates of injury are caused by the virus binding to and inhibiting ACE2, and potentially increasing levels of angiotensin II in the blood. Heart injury may also be caused by the virus directly entering and modifying the cells that line blood vessels and control the heart. This opens the door for more research to better treat heart injuries in patients with infectious diseases like COVID-19.  

Read the full paper:

Cheng MP, Cau A, Lee TC, Brodie D, Slutsky A, Marshall J, Murthy S, Lee T, Singer J, Demir KK, Boyd J, Ohm H, Maslove D, Goffi A, Bogoch II, Sweet DD, Walley KR, Russell JA; Angiotensin Receptor Blocker Coronavirus Study (ARBs) CORONA I. Acute Cardiac Injury in Coronavirus Disease 2019 and Other Viral Infections—A Systematic Review and Meta-Analysis. Crit Care Med. 2021 Apr 19. DOI: 10.1097/CCM.0000000000005026


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Action on Sepsis operates on the traditional, ancestral, and unceded territory of the Coast Salish peoples — xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) Nations. We invite everyone to reflect on the traditional territories and land that they currently work and live on.


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