COVID-19 and Cardiac Enzymes

Abstract

Since December 2019, the COVID-19 pandemic has caused widespread mortality and adverse economic impact throughout the world. Though predominantly a respiratory disease, concerns regarding cardiovascular effects have been highlighted. Cardiac biomarkers and their elevations in COVID-19 have been associated with higher cardiovascular disease burden and worse prognosis. The mechanism of cardiac enzyme elevation in COVID-19 can be explained under two broad categories- direct injury caused by downregulation of ACE2 and hypoxemia, and indirect injury, which is mediated by the cytokine storm. Cardiac troponin and high sensitivity troponin are the most extensively studied cardiac enzymes in COVID-19. Studies have shown comparable and in some cases better predictive value than traditional markers of inflammation like d-dimer, C-reactive protein, lactate dehydrogenase. Natriuretic peptides such as BNP have utility as a robust prognostic marker in COVID-19 when considering outcomes like the need for mechanical ventilation and mortality. Emerging data from studies investigating the role of newer cardiac biomarkers in COVID-19 like mid-regional proadrenomedullin, growth differentiation factor-15 have also yielded promising results. As advances are made in our understanding of the pathogenesis, diagnosis, and management of COVID-19, it is evident that investigating the role of cardiac biomarkers in COVID-19 provides vital information.