ABSTRACT
Background: Coronavirus 2019 disease (COVID-19), caused by SARS-CoV-2, can lead to cardiac impairment. Information on AF and on left atrial (LA) involvement in patients with COVID-19 pneumonia is limited, and we aimed to explore the association with mortality in these patients. Methods: This study was conducted from February 2020 to August 2020, in 4 centers (Umberto I°;M. Scarlato;Cardarelli and Monaldi hospitals). 280 hospitalized patients with COVID-19 TC-confirmed interstitial pneumonia were included in the analysis;mean age was 66.6 years, 112 were female. Results: A total of 70 patients had cardiac injury (defined as blood levels of high sensitivity Troponin I above the 99th-percentile upper reference limit), and these patients were older (mean age 74.5 [38-89] vs 56.3 [20-79] years;P<0.001) with increased body mass index (mean 29.3 [25.8-31.4] vs 26.9 [22.2-28.3];P<0.001);had higher levels of C-reactive protein (mean 99.8 [45.8-130.4] vs 37.9 [22.2-96.3] mg L-1;P<0.001), and of D-Dimer (mean 4.9 [3.2-7.3] vs 2.1 [0.5-3.4];P<0.001);had a higher proportion of multiple ground-glass opacities in computed tomography (CT) findings (49 of 70 patients [71.2%] vs 72 of 210 patients [34.7%];P<0.001) and multiple consolidations by lung ultrasound (52 of 70 patients [75.6%] vs 77 of 210 patients [36.6%];P<0.001). LV mass index and LA volume index were significantly increased in patients with cardiac injury (Table 1). Greater proportion of patients with cardiac injury showed AF occurrence (28 of 70 [40.0%] vs 23 of 210 [10.4%];P<0.0001). The more common complication in patients with cardiac injury was acute respiratory distress syndrome (47 of 70 [67.1%] vs 37 of 210 [17.6%];P<0.001). Patients with cardiac injury had higher mortality than those without cardiac injury (34 of 70 [48.5 %] vs 16 of 210 [7.6%];P<0.0001). In a multivariable Cox proportional hazards model, including clinical data, laboratory and echocardiographic indexes, in the overall population of COVID pneumonia patients, troponin levels (Hazard Ratio, 4.29 [95% CI, 1.85-8.43] P<0.001), LA volume index (HR 3.6 [95% CI, 1.15-7.48;p<0.001], PASP (HR: 3.9;[95% CI, 1.72-6.39] P<0.001) and AF occurrence (HR: 2.5;[95% CI, 1.22-5.4] P<0.001) emerged as independent predictors of in-hospital death. Conclusions: Our survey showed that higher prevalence of AF in patients with severe COVID-19 pneumonia was associated with higher risk of in-hospital mortality.