Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19

Stefanini, Giulio G.; Chiarito, Mauro; Ferrante, Giuseppe; Cannata, F.; Azzolini, Elena; Viggiani, Giacomo; Marco, Andrea De; Briani, Martina; Bocciolone, Monica; Bragato, Renato; Corrada, Elena; Gasparini, Gabriele L.; Marconi, Manuel; Monti, Lorenzo; Pagnotta, Paolo; Panico, Cristina; Pini, Daniela; Regazzoli, Damiano; My, Ilaria; Kallikourdis, Marinos; Ciccarelli, Michele; Badalamenti, Salvatore; Aghemo, Alessio; Reimers, Bernhard; Condorelli, Gianluigi

doi:10.1136/heartjnl-2020-317322

Cited by 84 publications

(82 citation statements)

References 14 publications

(15 reference statements)

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“…5 With respect to the role of natriuretic peptides in COVID-19 infection, an association of both BNP and NT-proBNP with unfavourable outcome has been reported in COVID-19, while the relevance of MR-proANP has not yet been investigated. 6,7 Interestingly, our study results rather support the use of MR-proANP as an independent predictor of worse outcome than NT-proBNP which failed to yield statistical significance in the multivariable Cox regression model. This premise is further supported by the fact that the area under the curve of MR-proANP was numerically larger compared to NT-proBNP.…”

Section: Clinical Evidencecontrasting

confidence: 49%

“…3,4 Several cardiovascular biomarkers-including cardiac troponin and N-terminal probrain natriuretic peptide (NT-proBNP)-have been identified as prognostic markers in COVID-19. [5][6][7] Atrial natriuretic peptide (ANP) is primarily expressed in the right atrium following atrial distension and exerts several physiological effects, including natriuresis, diuresis and vasodilation. 8 Hypoxaemia has also been suggested as a trigger of ANP release, which makes it an interesting target in both respiratory and cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

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Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Kaufmann

Ahmed

Kassem

et al. 2021

Eur J Clin Investigation

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Background: Mid-regional pro-atrial natriuretic peptide (MR-proANP) is a strong prognostic marker in several inflammatory, respiratory and cardiovascular conditions, but has not been studied in COVID-19 yet. Methods: This prospective, observational study of patients with COVID-19 infection was conducted from 6 June to 26 November 2020 in different wards of a tertiary hospital. MR-proANP, N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive cardiac troponin I levels on admission were collected and tested for their association with disease severity and 28-day mortality. Results: A total of 213 eligible patients with COVID-19 were included in the final analyses of whom 13.2% (n = 28) died within 28 days. Median levels of MR-proANP at admission were significantly higher in nonsurvivors (307 pmol/L IQR, [161 -532] vs 75 pmol/L [IQR, 43 -153], P < .001) compared to survivors and increased with disease severity and level of hypoxaemia. The area under the ROC curve for MR-proANP predicting 28-day mortality was 0.832 (95% CI 0.753 -0.912, P < .001).An optimal cut-off point of 160 pmol/L yielded a sensitivity of 82.1% and a specificity of 76.2%. MR-proANP was a significant predictor of 28-day mortality independent of clinical confounders, comorbidities and established prognostic markers

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Section: Clinical Evidencecontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Kaufmann

Ahmed

Kassem

et al. 2021

Eur J Clin Investigation

View full text Add to dashboard Cite

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“…Recently, Quin et al 30 reported that the cut‐offs of cardiac troponin for effective prognosis of 28‐day mortality of COVID‐19 were much lower than currently recommended thresholds for regular heart disease. Third, other cardiac markers, such as natriuretic peptides, which have demonstrated their prognostic value in combination with cardiac troponin, 32 were not included in the study. Finally, serial measurements of cardiac troponin, which may provide additional data to stratify risk, were not available 33 …”

Section: Discussionmentioning

confidence: 99%

Cardiac troponin and COVID‐19 severity: Results from BIOCOVID study

Guadiana-Romualdo

Morell-García

Rodríguez-Fraga

et al. 2021

Eur J Clin Investigation

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Background: Myocardial injury is a common finding in COVID-19 strongly associated with severity. We analysed the prevalence and prognostic utility of myocardial injury, characterized by elevated cardiac troponin, in a large population of COVID-19 patients, and further evaluated separately the role of troponin T and I. Methods: This is a multicentre, retrospective observational study enrolling patients with laboratory-confirmed COVID-19 who were hospitalized in 32 Spanish hospitals. Elevated troponin levels were defined as values above the sex-specific 99th percentile upper reference limit, as recommended by international guidelines. Thirty-day mortality was defined as endpoint. Results: A total of 1280 COVID-19 patients were included in this study, of whom 187 (14.6%) died during the hospitalization. Using a nonspecific sex cut-off, elevated troponin levels were found in 344 patients (26.9%), increasing to 384 (30.0%) when a sex-specific cut-off was used. This prevalence was significantly higher (42.9% vs 21.9%; P < .001) in patients in whom troponin T was measured in comparison with troponin I. Sex-specific elevated troponin levels were significantly associated with 30-day mortality, with adjusted odds ratios (ORs) of 3.00 for total population, 3.20 for cardiac troponin T and 3.69 for cardiac troponin I. Conclusion:In this multicentre study, myocardial injury was a common finding in COVID-19 patients. Its prevalence increased when a sex-specific cut-off and cardiac troponin T were used. Elevated troponin was an independent predictor of 30-day

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“…Cardiac troponin is increased in the case of community-acquired pneumonia, in the context of myocardial oxygen supply-demand mismatch and supply (21), and seems to correlate with the severity of respiratory impairment. Yet, few data are currently available on troponin level at the time of COVID-19 diagnosis (20,(22)(23)(24). Mechanisms of myocardial and tissue injury as well as coagulopathy associated with COVID-19 could be linked to the cytokine storm (25).…”

Section: Introductionmentioning

confidence: 99%

Predictive Factor for COVID-19 Worsening: Insights for High-Sensitivity Troponin and D-Dimer and Correlation With Right Ventricular Afterload

et al. 2020

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Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders.Objectives: To explore clinical and biological parameters of COVID-19 patients with hospitalization criteria that could predict referral to intensive care unit (ICU).Methods: Analyzing the clinical and biological profiles of COVID-19 patients at admission.Results: Among 99 consecutive patients that fulfilled criteria for hospitalization, 48 were hospitalized in the medicine department, 21 were first admitted to the medicine ward department and referred later to ICU, and 30 were directly admitted to ICU from the emergency department. At admission, patients requiring ICU were more likely to have lymphopenia, decreased SpO2, a D-dimer level above 1,000 ng/mL, and a higher high-sensitivity cardiac troponin (Hs-cTnI) level. A receiver operating characteristic curve analysis identified Hs-cTnI above 9.75 pg/mL as the best predictive criteria for ICU referral [area under the curve (AUC), 86.4; 95% CI, 76.6–96.2]. This cutoff for Hs-cTnI was confirmed in univariate [odds ratio (OR), 22.8; 95% CI, 6.0–116.2] and multivariate analysis after adjustment for D-dimer level (adjusted OR, 20.85; 95% CI, 4.76–128.4). Transthoracic echocardiography parameters subsequently measured in 72 patients showed an increased right ventricular (RV) afterload correlated with Hs-cTnI (r = 0.42, p = 0.010) and D-dimer (r = 0.18, p = 0.047).Conclusion: Hs-cTnI appears to be the best relevant predictive factor for referring COVID-19 patients to ICU. This result associated with the correlation of D-dimer with RV dilatation probably reflects a myocardial injury due to an increased RV wall tension. This reinforces the hypothesis of a COVID-19-associated microvascular thrombosis inducing a higher RV afterload.

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Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19

Cited by 84 publications

References 14 publications

Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Cardiac troponin and COVID‐19 severity: Results from BIOCOVID study

Predictive Factor for COVID-19 Worsening: Insights for High-Sensitivity Troponin and D-Dimer and Correlation With Right Ventricular Afterload

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