Characterization of Myocardial Injury in Patients With COVID-19

Abstract

Background Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. Objectives This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. Methods We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. Results A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. Conclusions Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.

COVID-19 myocarditis and postinfection Bell’s palsy

“… 4 5 In our patient, the myocardial involvement was global, suggesting diffuse inflammatory damage as a more probable pathway than regional ischaemic dysfunction due to microvascular thrombosis or atherosclerotic plaque rupture. 9 A particularity of the present case is the significant amount of myocardial injury, as reflected by an increase in TnT to >3× upper limit of normal combined with ECG and echocardiographic abnormalities, despite the patient’s young age and the absence of previous cardiovascular disease. The mechanisms underlying and the predisposition to COVID-19 myocarditis in young, otherwise healthy individuals remain poorly understood and are a research priority.…”

SARS-CoV-2 infection leads to cardiac pericyte loss, fibrosis, cardiomyocyte hypertrophy, and diastolic dysfunction

“…SARS-CoV-2 infection has several implications beyond the traditional respiratory syndrome COVID19, including the risk of developing severe cardiac injury, which in turn may exacerbate its severity [1][2][3] . Over 60% of patients hospitalized for COVID19 present with clear signs of myocardial injury 4 , with between 20 and 63% of patients showing increased biomarker levels, depending on the study 2,4,5 . Hospitalized patients present with a range of cardiac dysfunctions, including left ventricular wall motion abnormalities (23.7%), ventricular dysfunction (RV 26.3%, LV18.4%), diastolic dysfunction (13.2%), and pericardial effusions (7.2%) 4 .…”

“…Over 60% of patients hospitalized for COVID19 present with clear signs of myocardial injury 4 , with between 20 and 63% of patients showing increased biomarker levels, depending on the study 2,4,5 . Hospitalized patients present with a range of cardiac dysfunctions, including left ventricular wall motion abnormalities (23.7%), ventricular dysfunction (RV 26.3%, LV18.4%), diastolic dysfunction (13.2%), and pericardial effusions (7.2%) 4 . Additionally, long term consequences on cardiac function are suggested, as evidenced by the presence of cardiac fibrosis 6,7 .…”

Early measurement of blood sST2 is a good predictor of death and poor outcomes in patients admitted for COVID-19 infection

“…For instance, initial observation of heart damage associated to COVID-19 led to investigation of troponin, whose concentrations have been found to correlate poorly with COVID-19 prognosis. 6,7,8 . Accordingly, the search for more specific, earlier and clinical useful biomarkers of poor outcomes remains crucial.…”