Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection

Lala, Anuradha; Johnson, Kipp W.; Januzzi, James L.; Russak, Adam; Paranjpe, Ishan; Richter, Felix; Zhao, Shan; Somani, Sulaiman; Vleck, Tielman Van; Vaid, Akhil; Chaudhry, Fayzan; Freitas, Jessica K De; Fayad, Zahi A.; Pinney, Sean; Levin, Matthew A.; Charney, Alexander; Bagiella, Emilia; Narula, Jagat; Glicksberg, Benjamin S.; Nadkarni, Girish N.; Mancini, Donna; Fuster, Valentín

doi:10.1016/j.jacc.2020.06.007

Cited by 611 publications

(537 citation statements)

References 27 publications

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“…A larger retrospective study from New York not utilizing high-sensitivity assays showed that elevated troponin-I was associated with increased risk of death in a large US population. 21 Other studies have found that while inflammatory markers demonstrated correlation with ICU transfer or death, only CRP was found to be independently associated with these outcomes. 22 Our study population was larger and had much higher rates of cardiovascular risk factors and obesity.…”

Section: Discussionmentioning

confidence: 95%

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: 95%

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

et al. 2020

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“…3−5 But a recent study from New York showed a similar prevalence of myocardial injury in hospitalized Covid-19 patients. 7 There is evidence to suggest acute myocardial injury at hospital admission is also associated with increased in-hospital mortality in Covid-19. 8 However, ours is the first study to demonstrate increased mortality with higher cTnI levels.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to previous studies, we found that patients with myocardial injury were older, had a higher prevalence of the cardiovascular disease, and had higher inflammatory markers. [3][4][5]7 Possible mechanisms of myocardial injury in Covid-19 include direct damage to the cardiomyocytes, systemic inflammation, myocardial interstitial fibrosis, interferon -mediated immune response, exaggerated cytokine response by Type 1 and 2 helper T cells, coronary plaque destabilization, oxygen supply-demand mismatch, microembolic infarcts, hyperadrenergic state, and pulmonary embolism. 9,10 Based on the Fourth Universal Definition of Myocardial Infarction, there were very few patients who met the strict criteria for acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Elevated Cardiac Troponin I in Hospitalized Covid-19 Patients

Shah

Doshi

Chenna

et al. 2020

The American Journal of Cardiology

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This study aimed to determine if cardiac troponin I (cTnI) is an independent predictor of clinical outcomes and whether higher values are associated with worse clinical outcomes in Covid-19 patients. This case-series study was conducted at Phoebe Putney Health System. Participants were confirmed Covid-19 patients admitted to our health system between March 2, 2020 and June 7, 2020. Data were collected from electronic medical records. Patients were divided into 2 groups: with and without elevated cTnI. The cTnI were further divided in 4 tertiles. Multivariable logistic regression analysis was performed to adjust for demographics, baseline comorbidities, and laboratory parameters including D-dimer, ferritin, lactate dehydrogenase, procalcitonin and C-reactive protein. Out of 309 patients, 116 (37.5%) had elevated cTnI. Those with elevated cTnI were older (59.9 vs. 68.2 years, p <0.001), and more likely to be males (53.5% vs. 36.3%, p = 0.003). Elevated cTnI group had higher baseline comorbidities. After multivariable adjustment, overall mortality was significantly higher in elevated cTnI group (37.9% vs. 11.4%, odds ratio:4.45; confidence interval:1.78 to 11.14, p <0.001). Need for intubation, dialysis, and intensive care unit (ICU) transfer was higher in elevated cTnI group. Among those with elevated cTnI, mortality was 23.2% for 50th percentile, 48.4% for 75th percentile, and 55.2% for 100th percentile. Similarly, further increase in cTnI was associated with a higher need for intubation, dialysis, and ICU transfer. In conclusion, myocardial injury occurs in significant proportion of hospitalized Covid-19 patients and is an independent predictor of clinical outcomes, with higher values associated with worse outcomes.

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“…patients with elevated hs-cTnI levels [28][29], moreover, our ndings suggest that even when adjusted for in uences such as sex, age and disease history, hs-cTnI levels continued to work in predicting the progression of prognosis and the outcome of death in serious cases. As a result, early monitoring of cardiac injury-related markers, including hs-cTnI, can play a signi cant role in reducing the risk of death in serious condition.…”

Section: Discussionmentioning

confidence: 77%

Cardiac Troponin I Associated with Poor Prognosis and Death Risk in 726 Severe and Critical COVID-19 Patients: A Retrospective Cohort Study

Chen

Marmar

et al. 2020

Preprint

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Background: A few patients with coronavirus disease 2019 (COVID-19) may progress into irreparable outcomes. Early identification of patients with serious symptoms who may develop critical illness and even death is of considerable importance for personalizing treatment and balancing medical resources.Methods: In this retrospective study, demographic, clinical characteristics and laboratory tests from 726 patients with serious COVID-19 from Tongji Hospital (Wuhan, China) were analyzed. The standards for the serious type are guided by the Chinese management guideline for COVID-19. Patients were classified into critical group (174 cases) and severe group (552 cases) based on whether the composite endpoint was reached, and the former group was divided into the survivors (47 cases) and non-survivors (127 cases). Univariable and multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to investigate the risk factors associated with poor prognosis and mortality outcomes.Results: Male patients accounted for 62.1% and 51.6% in the critical group and severe group, with a median age of 68 and 65 years, respectively. Among critical cases there was a higher prevalence of chronic obstructive lung disease (p = 0.029) and chest distress (p = 0.040) than in severe cases. In the multivariable analysis, the risk factors associated with poor prognosis in severe cases were advanced age (p = 0.002), high respiratory rate (RR) (p < 0.0001), high lactate dehydrogenase (LDH) level (p = 0.021), high hypersensitive cardiac troponin I (hs-cTnI) level (p < 0.0001), and low platelet counts (p = 0.005) at admission. In the adjusted models, higher mortality outcomes in critical patients were associated with high hs-cTnI level (p = 0.037). By plotting ROC curves of different indices, hs-cTnI and LDH were found to be predictive factors for poor prognosis in patients with severe COVID-19.Conclusions: For the risk assessment of serious COVID-19 patients on admission, advanced age, high level of RR, LDH, hs-cTnI, and low platelet counts, constitute important risk factors for poor prognosis in severe cases, and the hs-cTnI level can be helpful in predicting fatal outcomes in critically ill patients.

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Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection

Cited by 611 publications

References 27 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

Prognostic Value of Elevated Cardiac Troponin I in Hospitalized Covid-19 Patients

Cardiac Troponin I Associated with Poor Prognosis and Death Risk in 726 Severe and Critical COVID-19 Patients: A Retrospective Cohort Study

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