ABC | Volume 114, Nº5, May 2020

Review Article Costa et al. The heart and COVID-19 Arq Bras Cardiol. 2020; 114(5):805-816 risk and might contribute to the decision making on hospital admission and case management. Figure 3 shows the flowchart for cardiovascular assessment in COVID-19 cases. The ECG can identify malignant cardiac arrhythmias, defined as sustained ventricular tachycardia inducing hemodynamic instability or ventricular fibrillation. Alterations in repolarization suggesting acute ischemia have been reported, mainly in patients with myocarditis. 14,18 The ECG plays an important role in the QTc interval monitoring of patients on hydroxychloroquine (HCQ) and azithromycin. Both drugs have been linked to QT interval prolongation. The combination of both drugs and the presence of fluid and electrolyte imbalance in patients with COVID-19 require QTc interval monitoring. In-patients should undergo an ECG 2-3 hours after the second dose of HCQ and daily thereafter. If QTc increases by >60ms or absolute Table 1 - Summary of the clinical characteristics of the major studies on COVID-19 Author N Type Age (years) Comorbidities Major findings Huang et al. 2020 17 41 Prospective 49 (41-58) - DM: 8 (20%) - AH: 6 (15%) - CVD: 6 (15%) - COPD: 1 (2%) - Cancer: 1 (2%) - 13 (32%) ICU admissions - 5 (12%) MI, and 4 (31%) to the ICU - 3 (7%) shock and 12 (29%) ARDS - Mortality: 6 (15%) Wang et al. 2020 30 69 Retrospective 42 (35-62) - AH: 9 (13%) - CVD: 8 (12%) - DM: 7 (10%) - COPD: 4 (6%) - Cancer: 4 (6%) - Hospitalizations: 44 (65.7%) - Mortality: 5 (7.5%) - Patients with DM, AH and CVD more often had hypoxemia (SatO 2 < 90%) - MI not assessed Chen et al. 2020 31 99 Retrospective 55 (21-82) - CVD: 40 (40%) - DM: 12 (12%) - Cancer: 1 (1%) - 57 (58%) hospitalizations, 17 (17%) ARDS, 4 (4%) shock - Mortality: 11 (11%) - Of the deceased, 63% were > 60 years and 33% had AH Wang et al. 2020 9 138 Retrospective 56 (42-68) - AH: 43 (31.2%) - CVD: 20 (14.5%) - DM: 14 (10.1%) - Cancer: 10 (7.2%) - Stroke: 7 (5.1%) - 36 (26%) ICU admissions, high prevalence of risk factors - 12 (8.7%) shock, 23 (16.7%) arrhythmias, 27 (19.6%) ARDS, and 10 (7.2%) MI - Mortality: 6 (4.3%) Zhang et al. 2020 29 140 Retrospective 57 (20–83) - AH: 42 (30%) - DM: 17 (12.1%) - CAD: 7 (5%) - Arrhythmias: 5 (3.6%) - Comparing severe x non-severe groups: median age 64 vs 51.5, p < 0.001 comorbidities 79.3% vs 53.7%, p = 0.002 d-dimer 0.4 vs 0.2, p<0.001 Guo et al. 2020 10 187 Retrospective 58.5 (±14.7) - AH: 61 (32.6%) - CAD: 21 (11.2%) - HF: 8 (4.3%) - DM: 28 (15%) - COPD: 4 (2.1%) - Cancer: 13 (7%) - 52 (27.8%) MI - Comparing normal tropo x high tropo: AH: 27% vs 63.5%, p 0.001 CAD: 3% vs 32.7%, p <0.001 HF: 0% vs 15.4%, p <0.001 - 43 deaths, 31 (59.6%) in the MI group - Mortality: 13.3% CVD without MI, and 69.4% CVD with MI Zhou et al 2020 12 191 Retrospective 56 (46-67) - AH: 58 (30%) - DM: 36 (19%) - CAD: 15 (8%) - COPD: 6 (3%) - Cancer: 2(1%) - MI: 24/145 (17%), greater in patients who died (22.2 [5.6-83.1] vs 3.0 [1.1-5.5], p <0.001) - HF 44 (23%), shock 38 (20%), ARDS 59 (31%) - 54 (28%) deaths, 67% with comorbidities Shi et al. 2020 11 416 Prospective 64 (21-95) - AH: 127 (30.5%) - DM: 60 (14.4%) - CAD: 44 (10.6%) - Stroke: 22 (5.3%) - HF: 17 (4.1%) - Cancer: 9 (2.2%) - 82 (19.7%) MI - High prevalence of AH, DM, CAD and HF in patients with MI - MI was related to higher mortality:  (42 of 82 [51.2%] vs 15 of 334 [4.5%]; p< .001) - MI was associated with ARDS: (48 of 82 [58.5%] vs 49 of 334 [14.7%]; p< .001) Guan et al. 2020 32 1099 Retrospective 47 (35-58) - COPD: 12 (1.1%) - DM: 81 (7.4%) - AH: 165 (15%) - CAD: 27 (2.5%) - Stroke: 15 (1.4%) - Câncer: 10 (0.9%) - Severely-ill patients: AH 41 (23.7%) - High CK-MB 90/657 (13.7%) - 12 (1.1%) shock, 37 (3.4%) ARDS, 1029 (93.6%) hospitalizations, 55 (5%) ICU admissions - Mortality: 15 (1.4%) DM, diabetes mellitus; AH, arterial hypertension; CVD, cardiovascular disease; COPD, chronic obstructive pulmonary disease; CAD, coronary artery disease; HF, heart failure; MI, myocardial injury; tropo, troponin; ARDS, acute respiratory distress syndrome; ICU, intensive care unit. 809