COVID-19 and acute myocardial injury: the heart of the matter or an innocent bystander?

Cheng, Richard K.; Leedy, Douglas

doi:10.1136/heartjnl-2020-317025

Cited by 48 publications

(52 citation statements)

References 8 publications

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“…Our results are in line with prior smaller studies in China demonstrating correlation between troponin and COVID-19 disease severity. 18 A multi-center retrospective cohort study from Wuhan, China studied 191 patients hospitalized with COVID-19. 19 Those with higher inhospital mortality were of older age, elevated sequential organ failure assessment (SOFA) score, and elevated D-dimer > 1g/mL on admission.…”

Section: Discussionmentioning

confidence: 99%

High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19

et al. 2020

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Background: High sensitivity troponin-T (hs-TnT) has been associated with mortality in patients hospitalized with COVID-19. We aimed to determine if hs-TnT levels and their timing are independent predictors of adverse events in these patients. Design: Retrospective chart review was performed for all patients hospitalized at our institution between March 23 rd and April 13 th , 2020 who were found to be COVID-19-positive. Clinical, demographic, and laboratory variables including initial and peak hs-TnT were recorded. Univariable and multivariable analyses were completed for a primary composite endpoint of inhospital death, intubation, need for critical care, or cardiac arrest. Results: In the 276 patients analyzed, initial hs-TnT above the median (17ng/L) was associated with increased length of stay, need for vasoactive medications, and death, along with the composite endpoint (OR 3.92, p < 0.001). Multivariable analysis demonstrated that elevated initial hs-TnT was independently associated with the primary endpoint (OR 2.92, p = 0.01). Latepeaking hs-TnT (OR 2.19 for each additional day until peak, p < 0.001) was also independently associated with the composite endpoint. Conclusions: In patients hospitalized with COVID-19, hs-TnT identifies patients at high risk for adverse in-hospital events, and trends of hs-TnT over time, particularly during the first day, provide additional prognostic information.

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Section: Discussionmentioning

confidence: 99%

High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19

et al. 2020

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“…There are a number of mechanisms for cardiac involvement in COVID-19 patients [38][39][40]. There may be direct invasion by the virus, causing a myocarditis, with resultant injury and even death of cardiomyocytes.…”

Section: Cardiomyopathymentioning

confidence: 99%

“…This may due to the affinity of the virus for ACE2, a membrane-bound aminopeptidase, which acts as a portal of viral entry, and downregulation of ACE2, leading to myocardial dysfunction [36]. The heart may also be indirectly affected by the systemic inflammatory state during the severe phase of the infection related to the cytokine storm where many "bystander" end-organs are damaged [40].…”

Section: Cardiomyopathymentioning

confidence: 99%

Mechanisms of Stroke in COVID-19

et al. 2020

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“…From there, it can cause direct damage to the cells or induce an inflammatory response by activation of cytotoxic T-lymphocytes. Additionally, patients with prior history of cardiac diseases may experience recurrent cardiovascular events due to atherosclerotic plaque rupture, catecholamine release, or demand ischemia (3,5).…”

Section: Introductionmentioning

confidence: 99%

Assessing the Elevation of Cardiac Biomarkers and the Severity of COVID-19 Infection: A Meta-analysis

Walker

Deb²,

Ling³

et al. 2020

J Pharm Pharm Sci

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- Purpose: Since December 2019, coronavirus disease 2019 infection has become a global pandemic. The cases of Coronavirus Disease 2019 (COVID-19)-related acute cardiac injury with unknown pathophysiologic mechanism has become increasingly prevalent. However, it is not yet understood how the extent of cardiac injury differs with the intensity of viral infection. In the current study, we aimed to assess the association between elevated cardiac biomarkers and the severity of COVID-19 infection. Methods: A systematic literature search was performed across PubMed and Embase databases from December 1, 2019 to July 10, 2020, to identify studies that reported cardiac biomarkers of troponin (TnI) and creatine kinase-myocardial band (CK-MB) in patients with COVID-19. These studies compared non-severe patients with severe patients, or survivors with non-survivors or medical patients with critically ill patients. The data were extracted for TnI, CK-MB, N-terminal-brain natriuretic peptide (NT-BNP), D-dimer, and lactate dehydrogenase (LDH), C-reactive protein (CRP), and interleukin 6 (IL-6). Wherever possible, the data were pooled for meta-analysis (Review Manager, RevMan. version 5.3) with standard or weighted mean or median difference and corresponding 95% confidence intervals (95% CI). Results: A total of 25 studies involving 5,626 patients were included in the present analysis. More severe COVID-19 infection was found to be associated with higher mean values of TnI (-0.54 [-0.72, -0.36]) (ng/mL), CK-MB (-1.55 [-2.23, -0.88]) (ng/mL) and (-4.75 [-13.31, 3.82]) (units/L), NT-BNP (-815.7 [-1073.97, -557.42]) (pg/mL), D-dimer (-1.4 [-2.04, -0.77]) (mcg/mL), and LDH (-176.59 [-224.11, -129.06]) (units/L), as well as CRP (-64.03 [-68.88, -59.19]) (mg/L) and IL-6 (-22.59 [-29.39, -15.79]) (pg/mL). Conclusions: There is significant association between elevated cardiac biomarkers and the severity of COVID-19, which underlines the increased risk of acute cardiac injury with more severe viral infection. This highlights the need to understand the cardiac history among the COVID-19 patients during initial assessment and for monitoring.

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COVID-19 and acute myocardial injury: the heart of the matter or an innocent bystander?

Cited by 48 publications

References 8 publications

High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19

High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19

Mechanisms of Stroke in COVID-19

Assessing the Elevation of Cardiac Biomarkers and the Severity of COVID-19 Infection: A Meta-analysis

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