OBJECTIVES: Severe acute respiratory syndrome-related coronavirus-2 binds and inhibits angiotensin-converting enzyme-2 . The frequency of acute cardiac injury in patients with coronavirus disease 2019 is unknown . The objective was to compare the rates of cardiac injury by angiotensin-converting enzyme-2-binding viruses from viruses that do not bind to angiotensin-converting enzyme-2 .
DATA SOURCES: We performed a systematic review of coronavirus disease 2019 literature on PubMed and EMBASE . STUDY SELECTION: We included studies with ten or more hospitalized adults with confirmed coronavirus disease 2019 or other viral pathogens that described the occurrence of acute cardiac injury . This was defined by the original publication authors or by : 1) myocardial ischemia , 2) new cardiac arrhythmia on echocardiogram, or 3) new or worsening heart failure on echocardiogram . DATA EXTRACTION: We compared the rates of cardiac injury among patients with respiratory infections with viruses that down-regulate angiotensin-converting enzyme-2, including H1N1, H5N1, H7N9, and severe acute respiratory syndrome-related coronavirus-1, to those with respiratory infections from other influenza viruses that do not bind angiotensin-converting enzyme-2, including Influenza H3N2 and influenza B . DATA SYNTHESIS: Of 57 studies including 34,072 patients, acute cardiac injury occurred in 50% (95% CI , 44-57 %) of critically ill patients with coronavirus disease 2019 . The overall risk of acute cardiac injury was 21% (95% CI , 18-26 %) among hospitalized patients with coronavirus disease 2019 . In comparison , 37% (95% CI , 26-49 %) of critically ill patients with other respiratory viruses that bind angiotensin-converting enzyme-2 (p = 0.061) and 12% (95% CI , 7-22 %) of critically ill patients with other respiratory viruses that do not bind angiotensin-converting enzyme-2 (p <0.001) experienced a cardiac injury .
CONCLUSIONS: Acute cardiac injury may be associated with whether the virus binds angiotensin-converting enzyme-2 . Acute cardiac injury occurs in half of critically ill coronavirus disease 2019 patients, but only 12% of patients infected by viruses that do not bind to angiotensin-converting enzyme-2.