Table 2.
Biomarkers, Radiographic, Electrocardiography, Echocardiography, and Biopsy Findings.
| Authors | Inflammatory markers | Cardiac markers | Radiographic findings | Electrocardiography | Echocardiography | CMR | Myocardial biopsy |
|---|---|---|---|---|---|---|---|
| Cizgic et al 13 | C reactive protein 94.6 mg/L | Troponin-998.1 ng/L | CT chest-small pericardial effusion and ground-glass opacification with consolidation | Atrial fibrillation besides heart rate of 150 bpm, concave ST elevation except for aVR lead | N/A | N/A | N/A |
| Yokoo et al 14 | N/A | Troponin T-33 pg/ml | Chest CT-small round ground-glass opacities, with multifocal distribution on both lungs | N/A | Reduction in the ejection fraction to 35% | Late enhancement areas with an ischemic pattern on the left ventricle base septum wall, with diffuse hypokinesis, and global systolic function | N/A |
| Pietsch et al 15 | NA | Troponin-83.6 ng/L CK-MB-7.14 ng/ml |
NA | NA | Severe diastolic dysfunction III with an increased wall thickness (inter-ventricular septum, 14 mm), and pericardial effusion | NA | EMB: Intra-myocardial inflammation with absence of signs of necrosis. Increased no. of CD45R0+ T memory cells (96.15 cells/mm2), CD3+ cells (20.54 cells/mm2), CD11a+ cells (24.36 cells/mm2), CD11b+ cells (91.56 cells/mm2), and CD54+ cells (area fraction 1.91%), histology: hypertrophied myocytes (diameter 31 μm) |
| Pavon et al 16 | C-reactive protein-466 mg/L, D-dimer-1210 ng/mL | Troponin (peak)- 1843 ng/L | Chest x-ray bilateral reticulation and ill-defined opacities, indicative of interstitial edema | N/A | Moderately reduced left ventricular ejection fraction of 47%( 72 h after CMR) | Reduced left-ventricular (LV) systolic function (42%), mild hypokinesia of the lateral wall. T2-mapping sequences showed myocardial edema (segmental T2 = 55-57 ms) | N/A |
| Khatri et al 17 | D-dimer-1068 ng/mL, procalcitonin-8.16 ng/mL, C-reactive protein110.85 mg/dL, Ferritin 66 ng/mL | Troponin- 544 ng/L, CK-MB54.3 ng/mL | N/A | Sinus tachycardia along with ST elevation in leads II, III, aVF, and ST depression in I, aVL | Severe global left ventricular systolic dysfunction, right ventricular (RV) enlargement causing its systolic dysfunction, and moderate-to-large pericardial effusion anterior to the Right ventricle | N/A | N/A |
| Hussain et al 18 | Troponin-18 ng/mL and CKMB-14.7 ng/mL | N/A | Diffuse ST elevation | Enlarged heart, marked decrease in ventricular systolic function with an ejection fraction of 20% | N/A | N/A | |
| Dalen et al 19 | C-reactive protein 11 mg/dl | Troponin T-108 ng/L, NTproBNP-1025 ng/L | N/A | Sinus tachycardia, insignificant ST elevation in inferior leads with a T-wave inversion in precordial leads | Left ventricular concentric hypertrophy | T1-mapping exhibited relaxation times of 1260-1270 ms in the anterolateral wall contrasted with 1090 ms in the septum. Late gadolinium enhancement in the anterolateral wall. | N/A |
| Zeng et al 20 | Interleukin-6(peak)- 272.40 pg/mL | Troponin I (peak)- 11.37 g/L, myoglobin (peak) > 390.97 ng/mL, NTpr(peak)- 22 500 pg/mL | Chest X-ray-Typical ground glass changes indicative of viral pneumonia | Sinus tachycardia without ST elevation and left axis deviation | Enlarged LV, diffuse myocardial dyskinesia, LVEF reduced to 32%, pulmonary hypertension, and normal RV function | N/A | N/A |
| Doyen et al 21 | N/A | Troponin I-9002 ng/L | Chest CT-bilateral crazy paving pattern, ground glass opacities and condensation | Diffuse T-wave inversion with the sign of left ventricular hypertrophy | Mild left ventricle hypertrophy, with normal left ventricular ejection fraction and nomal wall motion | Sub-epicardial late gadolinium enhancement of the apex and inferolateral wall | N/A |
| Faircloth et al 22 | C-reactive protein-
20.02 mg/dl, Ferritin-757 ng/ml ESR—78 mm/h |
Troponin-25 000 ng/L | NA | NA | NA | NA | NA |
| Coyle et al 23 | NA | Troponin I(peak) -7.33 on day 3, | N/A | Sinus tachycardia, with normal ST/T wave | Diffuse hypokinesis with relative apical sparing, with a left ventricular ejection fraction of 35–40%, no pericardial effusion | Diffuse edema of both atria and both ventricles along with small foci of late gadolinium enhancement | N/A |
| Luetkens et al 24 | C-reactive protein (pea k)—64.23 mg/L | Troponin T63.5 ng/L, NTproBNP—1178.0 pg/ml | Chest CT pulmonary ground glass peripheral infiltrates in the left upper lobe and discreet pleural and pericardial effusion | Normal | N/R | Diffuse interstitial myocardial edema with an increased T2 signal intensity ratio. T2 mapping showed diffuse myocardial inflammation( on day 10) | N/R |
| Jain et al 25 | Elevated inflammatory markers | Elevated troponin | Chest X-ray showed bilateral diffuse opacities | Age indeterminate inferior infarct versus left anterior fascicular block | EF <30% along with akinesis of the mid to apical myocardial segments | N/A | N/A |
| Mustafa et al 26 | C-reative protein—160 mg/L | Troponin I: 8.6 ng/ml | Chest x-ray was suggestive of increased interstitial prominence | Normal sinus rhythm with ST elevations in the antero-lateral distribution | N/A | N/A | N/A |
| Mansoor et al 27 | C-reactive protein: 27 mg/dl Ferritin: 928 ng/dl ESR: 82 mm/h WBC: 24000/μl, D-dimer: 3455ng/ml |
NT-proBNP: 4639 pg/ml, troponin T (hsTt): 118 ng/L |
N/A | Sinus tachycardia, PR elevation in aVR and PR depression in leads II and aVF on admission | Mildly decreased left ventricular function but no significant segmental wall motion abnormalities, mild mitral regurgitation, mildly enlarged right ventricle with normal right ventricular function, no tricuspid regurgitation, and no pericardial effusion. | N/A | N/A |
| Al-assaf et al 28 | Normal ranges of inflammatory markers and cardiac biomarkers. | N/A | Normal | Sinus bradycardia, no ST-T changes | Unremarkable study showing only a mildly dilated ascending aorta | T1 mapping showing a high value of 1062. T2 mapping showing an abnormal value of 57 |
N/A |
| Khalid et al 29 | C-reactive protein 23.10 mg/L, Interleukin-6 (IL-6) 781.46 mg/L, elevated lactate dehydrogen 334U/L and ferritin 457 ng/ml | Troponin 503 ng/l, proBNP35,000 pg/mL | Chest X-ray-diffuse bilateral pulmonary edema vs infiltrates | Normal sinus rhythm with a short PR interval | Severe left ventricular systolic dysfunction with segmental wall motion anomalies | N/R | N/R |
| Inciardi et al 30 | C reactive protein- 1.3 mg/dl mg/dl, D dimer- 500 U/F | Troponin T(peak)- 0.89 ng/mL, CKMB(peak)- 39.9 ng/mL, BNP(peak)—8465 pg/mL | N/A | Minimal diffuse ST elevation, low voltage in limb leads, ST depression, and T wave inversion in V1 and aV | Increased left ventricular wall thickness with diffuse hypokinesis, and LVEF of 40%. Large circumferential pericardial effusion of size 11 mm with the absence of tamponade | Diffuse biventricular apical hypokinesis, severe LV dysfunction (LVEF of 35%), Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema. | N/A |
| Fried et al 31 | C reactive protein: 0.0054 mg/dl, ferritin: 967ng/ml ESR: 166 ng/ml |
Troponin- 7900 ng/L, | N/A | Sinus tachycardia, ST segment elevation in leads I, II, aVL, V2-V6, and PR elevation and ST depression in aVR. Low voltage QRS complexes in the limbs leads. | EF: 30% (reduced) Severe concentric left ventricular hypertrophy, and a dilated, severely hypokinetic right ventricle. Pericardial effusion |
N/A | N/A |
| Wehit et al 32 | LDH-198 UI/l, ferritin- 723 ng/mL, Dimer D- 300 ng/mL | Troponin T- 16 pg/mL, BnP 370 pg/mL | Chest radiography revealed right basal opacities | N/A | Deterioration in both global and segmental longitudinal strain | N/A | N/A |
| Butler et al 33 | N/A | Troponin: 67 ng/L, NT-proBNP: 4529 pg/ml | N/R | N/R | N/R | N/A | N/A |
| Lagana et al 34 | N/A | Troponin:39.9 pg/ml, NT-proBNP: 1557.6 pg/ml | N/R | Ischemic alteration (66.66%) | Diffuse left ventricular hypokinesis 66.66%, 25%QTc prolongation | N/A | N/A |
| Kallel et al 35 | C-reactive protein: 315 mg/l, WBC count: 17 940/UL, Creatinine: 45 mg/l, D-dimer: 1.04 mg/l | Troponin I: 677 ng/L, CPK-MB: 19 UI/l |
CT chest showed typical findings of COVID-19 with ground-glass opacification | Diffuse ST elevation and simple monomorphic supraventricular extrasystoles | Normal systolic function | N/A | N/A |
| Ghurge et al 36 | NA | NA | NA | NA | NA | Normal left ventricular (LV) and right ventricle (RV) size and function, LV ejection fraction was 62%, area of mid myocardial/subepicardial late enhancement in the basal inferolateral wall in a non-ischemic pattern most consistent with a myocarditis type pattern, abnormal hyperintense MRI relaxation associated with the presence of edema, abnormal T2 hyperintense relaxation associated with the presence of edema. | N/A |
| Fath et al 37 | Creatinine-1.16 mg/dL INR-1.5 CRP- 306.8 mg/L LDH- 707U/L IL-6- 23 pg/mL D-dimer-32 563 ng/mL Ferritin-2831.22 ng/mL CK-86U/L |
Elevated Troponin I 7.454 ng/ml |
NA | Diffuse, mainly anterolateral, ST elevation | Reduced ejection fraction | NA | Multiple microscopic sites of myocardial ischemia together with thrombi in the left atrium and pulmonary vasculature and, scattered microscopic cardiomyocyte necrosis. Autopsy also revealed an adherent organizing left atrial thrombus (1.5 cm) and marked thromboembolism of the left pulmonary artery |
| Dabbagh et al 38 | C-reactive protein-15.9 mg/dl, ferritin-593 ng/ml, D-dimer- 6.52 μg/ml and interleukin 6(IL-6)- 8 pg/ml | Troponin I < 18 ng/L, pro-BNP-54 pg/mL | Chest X-ray enlarged cardiac silhouette | Shallow voltage in limb leads, non-specific ST alteration | A decrease in left ventricular ejection fraction to 40%, massive peripheral pleural effusion, an indication of early right ventricular diastolic collapse, dilated but collapsing inferior vena cava | N/A | N/A |
| Irabien-Ortiz et al 39 | C reactive protein- 10 mg/L | Troponin T(peak)- 1100 ng/dL, NTproBNP - 4421 ng/L | Chest X-ray- mild signs of vascular redistribution, with no infiltrations | Diffuse ST elevation and PR-segment depression | Concentric hypertrophy, diminished LV volumes, preserved LVEF, moderate pericardial effusion, absence of tamponade. After 2 h severe biventricular failure and diffuse myocardial edema | N/A | N/A |
| Albert et al 40 | N/A | Elevated troponin, NT-proBNP | No pathological features | Sinus tachycardia, no ST-T changes | Globally depressed LVEFof 20% with LVEDD of 5.8 cm, increased wall thickness | N/A | Inflammatory infiltrates with visualization of viral particles |
| Escher et al 41 | N/A | Troponin-3264 pg/mL, BNP- 12232(pg/mL)- | N/A | N/A | LVEF = 22% | N/A | Active myocarditis with CD3+ 106 cell/mm2 |
| Ford et al 42 | N/A | BNP 588 pg/mL, TnT normal | Left lower lobe consolidation | Wide-complex, irregular tachycardia with a LBBB morphology, as well as a long QT interval | Mild LV dilation with hypokinesis (EF 15%). New transthoracic echo revealed LV thrombus and worsening LV dilation | LV dilation with global hypokinesis, increased T2 signal, hyperemia, and edema |
N/A |
| Gauchotte et al 43 | N/A | Troponin I 8066 pg/mL and CK–MB 2103 UI/L) | Normal | Normal | Severe and diffuse LV hypokinesia, LVEF = 30% | N/A | Post mortem: Multifocal inflammatory infiltration, in both
ventricles and septum, composed in its majority of macrophages
and lymphocytes. The myocardium was edematous, containing
dystrophic cardiomyocytes, without necrosis. Strong presence of
anti-SARS-CoV nucleocapsid protein antibody in the myocardium |
| Hua et al 44 | N/A | Troponin T (peak)-253 ng/L | N/A | Sinus tachycardia, concave inferolateral ST elevation | Left ventricular ejection fraction was normal with pericardial effusion of size 11 mm and absence of cardiac tamponade | N/A | N/A |
| Jacobs et al 45 | Ferritin- 32 401 μg/L, interleukin 6 level- 281 pg/mL |
NTproBNP, 9,223 pg/mL, TnI 14 932 ng/L | Multiple patchy ground-glass opacifications in all lung fields | QRS widening and a positive Deflection at the end of the T wave |
Hyperdynamic ventricular function (inotropes). IVS 12mm, PW 11mm, LV EDD 48mm | NA | Post Mortem: Hypertrophic Cardiac tissue with patchy muscular, sometimes perivascular, and slightly diffuse interstitial mononuclear inflammatory infiltrates, dominated by lymphocytes. Positive immunohistochemical staining with E06 in morphologically degenerating and necrotic cardiomyocytes adjacent to the infiltrate of lymphocytes |
| Labani et al 46 | C-reactive protein 9 mg/L | TnT: 60 ng/L, BNP: 474 ng/L | Mild bilateral peripheral lower pulmonary lobe ground-glass opacities | Diffuse inverted T waves and elongated QT | Infero-septal and infero-apical LV wall hypokinesia, LVEF 56% and a moderate pericardial effusion | LV wall motion, normal LVEF 61% and persistence of a mild pericardial effusion. STIR and T2 map showed suggestive of myocardial edema in the basal inferior LV wall. LGE: multiple areas of inferior subepicardial and mid-wall | N/A |
| Spano et al 47 | Elevated C-reactive protein | Elevated troponin and NT-proBNP levels | CT chest-left heart congestion | Dynamic T- wave inversion | Diffuse hypokinesia with severely decreased left- and right-ventricular function | T2 weighted imaging and T2 mapping revealed diffuse thickening of the myocardium and pericardium attributable to edema | N/A |
| Tavazzi et al 48 | C reactive - protein 52.7 mg/L | Troponin I- 4332 ng/L | N/A | N/A | Dilated left ventricle, severe and diffuse LV hypokinesia with LV ejection fraction of 34% | N/A | N/A |
| Trogen et al 49 | C-reactive protein- 167 mg/L, D-dimer 1218 ng/mL, ferritin 1274.6 ng/mL | Troponin I: 2.97 ng/ml, BNP- 2124 pg/mL | N/R | Sinus tachycardia and T-wave inversion particularly in the inferior leads | Left ventricular ejection fraction mildly depressed without obvious intracardiac clots or pericardial effusion | The normal size of both ventricles along with slightly decreased systolic function. A segment of a mid-wall late gadolinium enhancement at the level of the inferior junction of both ventricles correlative to an area of increased T2 signal, along with an area of hypokinesia | N/R |
| Varga et al 50 | C-reactive protein: 232 mg/l D-dimers: 2.42 mg/l |
Troponin T: 51 ng/l, NTproBNP: 10 456 ng/l | Bilateral infiltration and ground glass opacities with consolidations in the right lung | N/A | Preserved left ventricular ejection fraction, but a severely enlarged left atrium (59ml/m2) indicating longstanding diastolic dysfunction | N/R | Postmortem: accumulation of inflammatory cells associated with endothelium, as well as apoptotic bodies, in the heart |
| Warchoł et al 51 | C-reactive protein levels-94 mg/l,D dimers:1.39 mg/l, lactate dehydrogenase: 369 U/l | Troponin T ranged from 72 ng/l to 102 ng/l, NT-proBNP: 2451 ng/l | N/R | N/R | N/R | Left atrial enlargement and global left ventricular hypokinesia with reduced left ventricular ejection fraction of 20%. Inferior and inferolateral wall large, patchy, and linear non-ischemic pattern of fibrosis with late gadolinium enhancement | N/R |
| Sardari et al 52 | CRP = 105 mg/L, ESR = 70 mm/h | Troponin T = <0.03ng/ml | Bilateral ground glass and consolidative opacities | N/R | Left ventricular dysfunction | Normal LV size, EF of 50 | No |
| Dahl et al 53 | CRP-230 mg/L, procalcitonin-2.1 μg/L | TnT- 90 ng/L, NT-proBNP - 160 ng/L | bibasal consolidations | sinus tachycardia with moderately flattened T-waves | deterioration of the left ventricular function,EF-40% | diffuse myocardial edema suggestive of significant acute myocardial injury. | N/R |
| Hu H et al 54 | N/A | Troponin T-10 000 ng/L,CKMB 112.9 ng/L, BNP—21 025 ng/L | CXR-cardiomegaly, CT-pulmonary infection, enlarged heart | III, AVF ST-segment elevation | enlarged heart and a marked decrease in ventricular systolic function, LVEF-27%,trace 2 mm pericardial effusion | N/R | N/R |
| Volis et al 55 | CRP-3.87 mg/dl | Troponin-I-965 ng/L | chest CT-unremarkable | minimal ST-depressions and T-wave inversions in lead III | Normal left ventricular ejection fraction-65%, normal function, no wall-motion abnormalities. | N/R | N/R |
| Besler et al 56 | CRP-0.0812 g/L | Troponin I-7.621 ng/mL,CKMB-21.92 μg/L,NT-proBNP-1525 ng/L | CXR-focal consolidation on the upper zone of left lung, CHEST CT-subpleural consolidation with ground-glass opacification in the left upper lobe | N/R | N/R | Myocardial wall edema, subepicardial late gadolinium enhancement of the posterolateral wall in the mid ventricle-suggestive of myocarditis,ef-64% | N/R |
| Gaine et al 57 | CRP-7 mg/L | Troponin T -25 ng/L, NTproBNP-3428 pg/mL | CXR-cardiomegaly, increased interstitial lung markings | atrial fibrillation | severely impaired LVEF of 20% and mitral regurgitation | Biventricular oedema suggestive of generalized severe myocarditis | N/R |
| Sheikh et al 58 | CRP-32.5 mg/dL,ESR-88 mm/h | Troponin-0.43 ng/mL, BNP-19 600 pg/mL | CXR-patchy bibasilar opacities | Accelerated junctional rhythm, non specific T wave changes | Left ventricular dysfunction-ejection fraction 30% | N/R | N/R |
| Salamanca et al 59 | N/R | troponin T-745 ng/l, CKMB-30 U/l, NTproBNP-24,167 pg/ml | CXR-bilateral pneumonia | Third-degree atrioventricular block | severely dysfunctional left ventricle,ejection fraction [LVEF] ∼15% | Diffuse edema, negative Late gadolinium enhancement | No significant inflammatory infiltrates |
| Naneishvili et al 60 | CRP-47 mg/L, D-dimer 579 ng/mL |
Troponin I-639 ng/L, CK-1403 U/L |
CXR-bilateral patchy air space shadowing consistent with SARS-CoV-2 pneumonia,CHEST CT-1 cm rim of pericardial fluid and minimal bi-basal lung inflammatory changes. | Atrial fibrillation converted to sinus rhythym by DC cardioversion | Moderate concentric biventricular hypertrophy, diffused left ventricular hypokinesia with moderate to severe left-ventricular systolic dysfunction EF-37% and pericardial effusion with no signs of tamponade | N/R | N/R |
| Kim et al 61 | N/R | Troponin I-1.26 ng/mL,NT-proBNP-1929 pg/mL | CXR-multifocal consolidation on both lung fields and cardiomegaly, CHEST CT-multifocal consolidation and ground-glass opacification in both lungs in the lower lobe. | Multiple premature ventricular complexes | Severe left ventricular systolic dysfunction | Myocardial edema, Extensive transmural late gadolinium enhancement | N/R |
| Nikoo et al 62 | CRP-23 mg/L,ESR-4 mm/h | Troponin I 10.32 Mic gr/L),CKMB-83 IU/L | N/R | Sustained ventricular tachycardia | Biventricular dilation and global hypokinesia with left ventricular ejection fraction-20–25%. | CMR after discharge-normal ventricles size, EF of 52%, diffuse myocardial inflammation of the LV myocardium | N/R |
| Sala et al 63 | CRP: 18 mg/l | Troponin T: 135 ng/L, NT pro BNP: 512 pg/ml | B/L opacity in lungs | Mild ST-segment elevation(V1-V2 and aVR), ST- depression (V4-V6), and diffuse U waves | LVEF = 43%, inferolateral wall hypokinesis and no pericardial effusion | Hypokinesia of left ventricle mid and basal segment, diffuse myocardial oedema | T lymphocytes inflammatory infiltrates and necrosis |
| Yuan et al 64 | N/R | N/R | No ground glass appearance in Lungs. | Ventricular Tachycardia | N/R | Increased left ventricular apical region | N/R |
| Warchol et al 65 | CRP: 94 mg/l, D-dimer: 1.39 mg/l | Trop I: 102 ng/L, NTpro BNP: 2451 ng/l | N/R | 55% | Left atrial enlargement, global left ventricular hypkinesia, myocardial edema with ejection fraction of 20% | N/R | |
| Asif and Ali 65 | P1: N/R, P2: N/R | P1: 0.17ng/ml. P2: 1.6 ng/ml | P1: B/L Diffuse opacity, P2: B/L Diffuse lung opacity | P1: ST- elevation in lead I, aVL and V1-V4 T wave change, P2: ST- elevation in lead V2-V6 and Q waves in lead V4-V6 | P1: 70%, P2: 65% | P1: No regional wall abnormalities, P2: No regional wall abnormalities | N/R |
| Khalid et al 66 | P1: CRP: 8.5 mg/L, D-dimer: 0.73ug/mL, ESR: 29mm/h, Ferritin: 559 ng/mL. P2: Normal | P1: Troponin-I(116 ng/mL), P2: Troponin-I( 2.7 ng/mL), NT pro- BNP(2917) pg/ml | P1: N/R, P2: N/R | P1: Sinus Rhythm,inferioposterior infarct without ST- elevation. P2: Sinus tachycardia, low amplitude QRS, and poor R- wave progression | P1: EF = 45% . P2: EF = 25% | P1: N/R, P2: N/R | N/R |
| Ng et al 67 | Elevated CRP: 4, WBC: 4 | Elevated Troponin: 7 patients | N/R | 14 patients have ECG changes for Myocardial injury | N/R | 14 patients have abnormal CMR finding (High T1 and /or T2, +/- no ischemic LGE) | N/R |
| Jirak et al 68 | C-reactive protein: 27.5 ± 12.2 mg/dl, CK levels: 518 U/L, D-dimer: 6720 ng/ml, Procalcitonin: 1.59 ng/ml WBC count: 14820/μl |
Troponin: 354 ng/L CK-MB: 22 U/L NT-proBNP: 811 pg/ml |
35 Patient shownCardiomegaly (46%), 26 Patient shown Pulmonary venous congestion (34.2%) | N/R | 24 patient shown LVEF, Pericardial effusion in 3 patients. | N/R | N/R |
| Yan et al 69 | CK levels: 80 U/L, Creatinine: 0.72-0.92 mg/dl, Ferritin: 975ng/ml[Male] 748 ng/ml [Female], ESR: 35 mm/h, Procalcitonin: 5850/μl, D-dimer: 1.43ng/ML |
Troponin: 6.9 ng/L, CK-MB: 1.2 ng/ml, NT-proBNP: 221 pg/ml |
N/R | N/R | N/R | N/R | N/R |
| Kunal et al 70 | D-dimer = 84.2% (elevated) | Troponin T = 0.66 ± 1.28 ug/L, CK-MB(U/L) = 55.7 ±3 0.1 | N/R | ST- T change = 32.1%, Max QTc = 457.37 ± 32.7 | N/R | N/R | N/R |