Table 1. Summary of Findings on Cardiac Complications Associated with COVID-19.

[1,14-21,25,28,30,33,35-40,44-50]

Authors	Design	Main Findings
Aghagoli et al., [19]	Case series   N = 13	COVID‐19 patients with pre-existing cardiovascular disease are counted in greater frequency in ICUs and suffer higher mortality rates. Cardiac presentations for COVID‐19 include acute pericarditis, left ventricular dysfunction, and acute myocardial injury.
Alqahtani et al., [37]	Case series   N = 117	COVID-19 is positively associated with heart failure, arrhythmias, microvascular angiopathy, and long-term cardiac damage.
Ammirati et al., [14]	Case series N = 23	Acute myocarditis (AM) is a rate cardiovascular complication of COVID-19. AM prevalence among hospitalized COVID-19 patients was 2.4/1000 hospitalizations (definite) and 4.1/1000 (possible). The median age of definite cases was 38 years, and 38.9% were female. Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality = 6.6%.
Ashton et al., [46]	Systematic Review N = 9	Existing data indicate an increased risk of severe complications and mortality in those who contract COVID-19 with pre-existing CV disease (CVD) or who present with risk factors such as hypertension, diabetes mellitus, hypercholesterolemia, and obesity. A significant risk factor for respiratory failure necessitating mechanical ventilation was also determined to be the high prevalence of obesity among COVID-19 hospital patients. It became clear that acute cardiac injury (myocarditis, pericarditis, and reduced ventricular function) following infection with COVID-19 was frequent as the evidence and incidence of the multisystem nature of COVID-19 became known. Long-term cardiac symptoms like dyspnea and tiredness (36%), palpitations (20%), and unusual chest discomfort (17%) are all linked to COVID-19. Due to its association with high morbidity and the worsening of underlying CV problems, Long COVID is concerning for patients who have CVD.
Brogi et al., [15]	Systematic Review N = 49 Acute cardiac injury (ACI) (n = 20) Heart failure (n = 10) Myocardial infarction (n = 7) Takotsubo syndrome (n = 6) Myocarditis (n = 12) Pericardial effusion (n = 5) Arrhythmias (n = 13) Right ventricular dysfunction (n = 6) Meta-Analysis N = 7 The RR = 0.20. 95% CI: [0.17; 0.24], p < 0.00001, I2 = 0.75.	The most common cardiac problem was ACI (20–45%). Acute cardiac injury (ACI) is an independent risk factor for severe forms of SARS-CoV-2 infection and an independent predictor of mortality. Possible arrhythmic alterations (incidence 3-60%) have to be taken into account for the potential complications and the ensuing hemodynamic instabilities. Patients with acute cardiac injury are significantly older, have more comorbidities, are more likely to develop complications, and have higher mortality rates. The most prevalent comorbidity is hypertension (30-59.8%). This group of individuals had a high rate of CVD (up to 57%) and only 10% had coronary artery disease. Patients with CVD showed greater rates of ICU admission, severe form prevalence, and mortality.
Cannata et al., [25]	Meta-Analysis N = 15 The RR = 0.62. 95% CI: [1.20; 2.20], p = 0.002.	Mortality among patients with CV diseases was higher relative to periods outside the pandemic, independent of co-infection with COVID-19. The effect was larger in studies with the biggest decline in admission rates, suggesting a sicker cohort of patients in this period.
Chang et al., [28]	Comprehensive Review (N = 35) Cardiomyopathy (n = 1) Myocarditis (n = 6) Heart failure (n = 1) Arrhythmia (n = 1) Thromboembolism (n = 2) Cardiac events (n = 24)	SARS-CoV-2 may either induce new cardiac pathologies and/or exacerbate underlying cardiovascular diseases as the high inflammatory burden of COVID-19. The presence of cardiac injury, heart failure, and myocarditis are independent factors associated with mortality.
Denegri et al., [35]	Case series N = 902	Arrhythmias (AF) are quite common at admission in COVID-19 infection and have been associated with worse prognosis. AF at baseline ECG determined a significantly higher risk of mortality compared to other rhythms and even to the history of AF.
Jafari-Oori et al., [16]	Meta-Analysis N = 26	Patients with cardiac issues with COVID-19 are significantly more likely than those without to get severe disease, require ICU admission, or pass away. Patients with cardiac injury who have COVID-19 are more likely to develop a severe form of the disease, be admitted to the intensive care unit, or pass away. The pooled rates for AMI were 21%, heart failure was 14%, arrhythmia was 16%, cardiac arrest was 3.46%, and acute coronary syndrome was 1.3% in COVID-19.  AMI and shock had a combined incidence of 33% in individuals with severe illness.
Kochi et al., [1]	Case Series N = 6	Arrhythmic problems and myocardial damage are both brought on by COVID-19 infection.
Kole et al., [47]	Comprehensive Review N = 25	Clinical manifestations of COVID-19 during acute and post-acute syndrome include myocardial injury, dysrhythmias, atrial arrhythmia, AV block, sinus tachycardia, sinus bradycardia, heart failure, coagulation abnormalities (DVT, PE, VTE). Other complications include pericarditis, pericardial effusion, and Takotsubo syndrome. Poor research has been done on post-COVID-19 syndrome, which affects COVID-19 survivors of various severities of disease and ages. Chest tightness, cardiac arrhythmias, palpitations, hypotension, an elevated heart rate, venous thromboembolic disorders, myocarditis, and acute/decompensated HF were all associated with cardiovascular events.
Kunutsor et al., [20]	Systematic Review (N = 17) Meta-Analysis (N = 17)	For COVID-19 associated: § Heart failure (n = 4): RR = 17.6%; 14.2-21.2; I2 = 32%; 95% CI 0, 76%; p = 0.20. § Myocardial injury (n = 11): RR = 11.8%; I2 = 87%; 95% CI 79, 92%; p < 0.01. § Cardiac arrythmia (n = 6): RR = 9.3%; 5.1-14.6; I2 = 78%; 95% CI 52, 90%; p < 0.01. § Acute Coronary Syndrome (n = 2): RR = 6.2% (1.8-12.3). The incidence of myocardial injury was higher in older age groups and groups with a higher prevalence of pre-existing hypertension; the incidence of myocardial injury was similar in groups with a high or low prevalence of pre-existing CVD.
Long et al., [17]	Case series N = 37	COVID-19 is associated with myocardial injury and myocarditis, AMI, heart failure, arrhythmias, and VTE.
Nadarajah et al., [48]	Meta-Analysis (N = 158)	The collateral damage of COVID-19 to CV clinical services has been high. There have been fewer procedures, hospitalizations, procedures, and consultations and increased mortality among patients with CV conditions.
Osoro et al., [49]	Scoping Review N = 44	Cardiovascular complications noted in COVID-19 patients include myocardial infarction, myocarditis, arrhythmia, myocardial interstitial fibrosis, endothelial cell dysfunction, vasculitis, thromboembolism, and dysautonomia. Overall, the development of cardiovascular complications in COVID-19 patients worsened the pandemic situation.
Peiris et al., [40]	Scoping Review N = 63	The overall frequency of acute cardiac injury ranged from 15% to 33%. The main cardiac complications were arrhythmias (3.1% - 6.9% in non-severe patients, 33.0% - 48.0% in severe disease), acute coronary syndromes (6% - 33% in severe disease, and myocarditis.
Ramadan et al., [33]	Case Series N = 73	COVID-19 is positively associated with higher rates of cardiac complications (CC). Most common CC: myocarditis, heart failure, myocardial injury, arrhythmia. Patients with a prior history of CVD appear to be more susceptible to CC.
Saha et al., [50]	Contemporary Review N = 68	A variety of arrhythmic manifestations in patients with COVID-19 range from relatively benign conditions such as transient sinus bradycardia to potentially life-threatening conditions such as ventricular arrhythmias and sudden cardiac death. Atrial fibrillation is the most common arrhythmia seen in acute COVID-19 patients.
Sahranavard et al., [36]	Systematic Review N = 22 Meta-Analysis N = 22	COVID-19 is associated with a higher incidence of various cardiac complications: Arrhythmia (n = 3): RR = 10.11; CI 95% [5.12; 19.00], p < 0.001, I2 = 75.21. Heart Failure (n = 4); RR = 22.34; CI 95% [14.05; 33.60], p < 0.001, I2 = 79.44. Myocardial Injury (n = 13); RR = 17.85; CI 95% [13.18; 23.72], p < 0.001, I2 = 86.84.
Salabei et al. [32]	Case series N = 89	The cardiac complications of COVID-19 most frequently include myopericarditis leading to shock and increased morbidity and mortality.
Shafi et al., [21]	Systematic Review N = 61	Evidence supports a clear correlation between cardiovascular disease and COVID‐19 severity. Hypertension and diabetes are the most prevalent comorbidities associated with adverse cardiovascular outcomes. Cardiac manifestations are an important aspect of disease manifestation in COVID‐19, with atrial fibrillation, myocarditis, heart failure, and cardiogenic shock the most commonly reported manifestations.
Sousa Rêgo et al., [44]	Narrative Review N = 34	The most frequent cardiovascular complication was acute cardiac damage, which was documented in 28 (25.9%) patients. Heart failure, cardiogenic shock, and acute coronary syndrome were each reported in 4 (2.8%) patients, while pericardial effusion was observed in 2 (1.9%). Stress cardiomyopathy may be a serious consequence of COVID-19 due to its association with a systemic cytokine storm. Late cardiovascular complications include myocardial inflammation, regional scar, and pericardial enhancement.
Srinivasan et al., [34]	Case Series N = 83	Although the incidence of cardiac complications in non-comorbid patients with COVID-19 may be considered low, its significance should not be underestimated when considering the potential impact on healthcare systems. Most common COVID-19-associated cardiac complications: § Direct complications such as direct cardiotoxicity, microvascular dysfunction, acute coronary syndrome, heart failure, myocarditis, arrhythmia, and venous thromboembolism. § Indirect complications such as long-term inflammatory changes, hypoxemia-mediated effects, and supply-demand mismatch.
Toloui et al., [38]	Systematic Review N = 40 Meta-Analysis N = 40	Acute cardiac injury, heart failure, and cardiac arrest were all more common than they were in the general population: 19.46% (95% CI: 18.23-20.72), 19.07% (95% CI: 15.38-23.04), and 3.44% (95% CI: 3.08-3.82), respectively. When patients have acute cardiac damage, the overall odds of morality RR is 14.24 (95% CI: 8.67-23.38). When the study was restricted to those with aberrant serum troponin levels, the pooled odds ratio for mortality was 19.03 (95% CI: 11.85-30.56). In COVID-19 patients, acute cardiac damage and elevated serum troponin levels were the most frequent cardiac consequences.
Vosko et al.,  [30]	Comprehensive Review	Cardiovascular sequelae of COVID-19 and long-term CVD risk modification include myocarditis, acute coronary syndrome, heart failure, thromboembolic complications, and arrhythmia.
Welty et al., [18]	Comprehensive Review N = 68	The relationship between cardiovascular diseases and COVID-19 is bidirectional, which implies that pre-existing cardiovascular comorbidities increase the morbidity and mortality of COVID-19. Newly emerging cardiac injuries occur in the settings of acute COVID-19 in patients with no pre-existing cardiovascular disease.
Zuin et al., [39]	Systematic Review N = 6 Meta-Analysis N = 6	Acute HF represents a frequent complication of COVID-19 infection associated with a higher risk of mortality in the short-term period. The polled incidence of heart failure (HF) as a cardiac complication in COVID-19 patients was 20.2% of cases (95% CI: 11.1–33.9%, p < 0.0001 I2 = 94.4%). The related mortality risk in COVID-19 patients OR = 9.36% (95% CI: 4-76-18.4, p < 0.0001, I2 = 56.6%. Age was used as a moderator variable in the meta-regression analysis, but it was unable to establish a statistically significant correlation with either the mortality risk among the same participants (p = 0.053) or the incidence of acute HF onset as a consequence of COVID-19 disease (p = 0.062).