Cardiac manifestations in COVID-19 patients-A systematic review

J Card Surg. 2020 Aug;35(8):1988-2008. doi: 10.1111/jocs.14808. Epub 2020 Jul 11.


Objectives: The coronavirus disease-2019 (COVID-19) pandemic has resulted in the worst global pandemic of our generation, affecting 215 countries with nearly 5.5 million cases. The association between COVID-19 and the cardiovascular system has been well described. We sought to systematically review the current published literature on the different cardiac manifestations and the use of cardiac-specific biomarkers in terms of their prognostic value in determining clinical outcomes and correlation to disease severity.

Methods: A systematic literature review across PubMed, Cochrane database, Embase, Google Scholar, and Ovid was performed according to PRISMA guidelines to identify relevant articles that discussed risk factors for cardiovascular manifestations, cardiac manifestations in COVID-19 patients, and cardiac-specific biomarkers with their clinical implications on COVID-19.

Results: Sixty-one relevant articles were identified which described risk factors for cardiovascular manifestations, cardiac manifestations (including heart failure, cardiogenic shock, arrhythmia, and myocarditis among others) and cardiac-specific biomarkers (including CK-MB, CK, myoglobin, troponin, and NT-proBNP). Cardiovascular risk factors can play a crucial role in identifying patients vulnerable to developing cardiovascular manifestations of COVID-19 and thus help to save lives. A wide array of cardiac manifestations is associated with the interaction between COVID-19 and the cardiovascular system. Cardiac-specific biomarkers provide a useful prognostic tool in helping identify patients with the severe disease early and allowing for escalation of treatment in a timely fashion.

Conclusion: COVID-19 is an evolving pandemic with predominate respiratory manifestations, however, due to the interaction with the cardiovascular system; cardiac manifestations/complications feature heavily in this disease, with cardiac biomarkers providing important prognostic information.

Keywords: COVID-19; SARS-CoV-2; cardiac biomarkers; cardiac manifestations; cardiovascular risk factors; clinical presentations.

Publication types

  • Systematic Review

MeSH terms

  • Betacoronavirus*
  • Biomarkers / blood
  • COVID-19
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / virology*
  • Coronavirus Infections / epidemiology*
  • Creatine Kinase / blood
  • Creatine Kinase, MB Form / blood
  • Humans
  • Myoglobin / blood
  • Natriuretic Peptide, Brain / blood
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Prognosis
  • Risk Factors
  • SARS-CoV-2
  • Shock, Cardiogenic / virology
  • Troponin / blood


  • Biomarkers
  • Myoglobin
  • Troponin
  • Natriuretic Peptide, Brain
  • Creatine Kinase
  • Creatine Kinase, MB Form