Cardiovascular Journal of Africa: Vol 32 No 2 (MARCH/APRIL 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 2, March/April 2021 AFRICA 79
Cardiovascular view of intermediate and high-risk
COVID-19 patients: single-centre experience with low
mortality and intensive care hospitalisation rates
Alpay Medetalibeyoglu, Samim Emet, Naci Senkal, Mehmet Aydogan, Murat Kose, Tufan Tukek
Abstract
Aim: The purpose of this article was to report the low rates of
intensive care unit admission and mortality in intermediate-
and high-risk COVID-19 patients, and to share our clinical
approach with other colleagues. In addition, we sought to
reveal the relationship between myocardial injury and clinical
outcomes such as death, intensive care unit uptake and hospi-
tal stay, and the relationship between inflammatory param-
eters and cardiac biomarkers in a cardiovascular perspective.
Methods: Patients admitted to the emergency department in
the Department of Internal Medicine, Faculty of Medicine,
Istanbul University, with laboratory or clinically and radio-
logically confirmed COVID-19 were included in this retro-
spective cross-sectional study, which was conducted from 11
March to 10 April 2020. The demographic (age and gender)
and clinical (symptoms, co-morbidities, treatments, compli-
cations and outcomes) characteristics, laboratory findings,
and results of cardiac examinations (cardiac biomarkers and
electrocardiography) of patients during hospitalisation were
collected from their medical records by two investigators.
Data were analysed using SPSS version 25.0 (IBM). A two-
sided p < 0.05 was considered statistically significant. Analysis
began on 11 April 2020.
Results: Mortality and intensive care unit admission rates
were statistically significantly higher in patients with cardiac
injury than in those without. There was a positive correla-
tion between levels of high-sensitivity TNT and fibrinogen,
D-dimer, ferritin, procalcitonin and C-reactive protein (r =
0.24, p < 0.01; r = 0.37, p < 0.01; r = 0.25, p < 0.01, r = 0.34, p
< 0.01; r = 0.31, p < 0.01).
Conclusion: The first general data of our 309 patients regard-
ing low mortality and intensive care admission rates, and
particular treatment algorithms specific to our centre should
be helpful in determining better treatment strategies in the
future. Our study emphasises the importance and frequency
of cardiovascular outcomes, and the significance of some
cardiac biomarkers in predicting COVID-19 prognosis.
Keywords: cardiovascular outcomes, myocardial injury, troponin,
COVID-19, mortality, intensive care hospitalisation
Submitted 7/7/20, accepted 30/8/20
Published online 9/11/20
Cardiovasc J Afr 2020; 31: 79–86
DOI: 10.5830/CVJA-2020-041
In December 2019, in Wuhan city of Hubei province in
China, a novel coronavirus [severe acute respiratory syndrome
coronavirus-2 (SARS-CoV-2)] emerged with cases of treatment-
resistant pneumonia, and subsequently spread rapidly, causing
the first pandemic of the 21st century.1-3 After it was officially
detected in our country on 11 March 2020, the number of cases
has increased rapidly.
The main cause of death in coronavirus disease 2019
(COVID-19) is severe acute respiratory failure.1,4-6 In published
patient series, 40% of patients hospitalised due to COVID-19
positivity had cardiovascular or cerebrovascular disease, 17%
had arrhythmia and 7% had acute cardiac damage. In some case
reports, COVID-19 has been reported in the form of the first
acute onset of heart failure, acute myocardial infarction (MI),
myocarditis or sudden cardiac arrest.1,4,5
The four main effects of COVID-19 on the cardiovascular
system are listed below:7
• The risk of serious illness and death increases with COVID-
19 in the presence of accompanying cardiovascular disease.
• COVID-19 is responsible for a large number of direct or indi-
rect cardiovascular complications such as myocarditis, myocar-
dial damage, arrhythmia and venous thromboembolism.
• Drugs that are in research and/or development phase for
COVID-19 have various cardiovascular side effects.
• Healthcare professionals providing cardiovascular care
services play a role as host or carrier in COVID-19 spread.
The purpose of this article was to report the low intensive care
unit (ICU) admission and mortality rates in intermediate- and
high-risk COVID-19 patients and to share our clinical approach
with other colleagues. In addition, we reveal the relationship
between myocardial injury and clinical outcomes such as
death, ICU admission and hospital stay, and the relationship
between inflammatory parameters and cardiac biomarkers in a
cardiovascular perspective.
Methods
Patients admitted to the emergency department in the
Department of Internal Medicine at Istanbul University Faculty
of Medicine, with laboratory or clinically and radiologically
confirmed COVID-19 were included in this retrospective, cross-
sectional study, which was conducted from 11 March to 10 April
2020. The patients with COVID-19 enrolled in this study were
diagnosed according to World Health Organisation interim
Department of Internal Medicine, Istanbul Faculty of
Medicine, Istanbul University, Istanbul, Turkey
Alpay Medetalibeyoglu, MD
Naci Senkal, MD
Murat Kose, MD
Tufan Tukek, MD
Department of Cardiology, Istanbul Faculty of Medicine,
Istanbul University, Istanbul, Turkey
Samim Emet, MD,
Mehmet Aydogan, MD