Troponin Elevation in Older Patients with Acute Pneumonia: Frequency and Prognostic Value

Putot, Alain; Bouhey, Emmanuel; Tetu, Jennifer; Barben, Jérémy; Timsit, E.; Putot, Sophie; Ray, Patrick; Manckoundia, Patrick

doi:10.3390/jcm9113623

Cited by 10 publications

(4 citation statements)

References 50 publications

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“…Troponin levels can be elevated due to multiple reasons, including elevated levels in chronic kidney disease and patients with atrial fibrillation [13,14]. A sole measure of troponin does not confirm acute cardiovascular disease but can be a bystander to other severe diseases, e.g., pneumonia [15].…”

Section: Cardiovascular Events and Troponinmentioning

confidence: 99%

Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study

Gunawardene

Geßler

Wohlmuth

et al. 2021

JCM

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Background: Acute myocardial injury (AMJ), assessed by elevated levels of cardiac troponin, is associated with fatal outcome in coronavirus disease 2019 (COVID-19). However, the role of acute cardiovascular (CV) events defined by clinical manifestation rather than sole elevations of biomarkers is unclear in hospitalized COVID-19 patients. Objective: The aim of this study was to investigate acute clinically manifest CV events in hospitalized COVID-19 patients. Methods: From 1 March 2020 to 5 January 2021, we conducted a multicenter, prospective, epidemiological cohort study at six hospitals from Hamburg, Germany (a portion of the state-wide 45-center CORONA Germany cohort study) enrolling all hospitalized COVID-19 patients. Primary endpoint was occurrence of a clinically manifest CV-event. Results: In total, 132 CV-events occurred in 92 of 414 (22.2%) patients in the Hamburg-cohort: cardiogenic shock in 10 (2.4%), cardiopulmonary resuscitation in 12 (2.9%), acute coronary syndrome in 11 (2.7%), de-novo arrhythmia in 31 (7.5%), acute heart-failure in 43 (10.3%), myocarditis in 2 (0.5%), pulmonary-embolism in 11 (2.7%), thrombosis in 9 (2.2%) and stroke in 3 (0.7%). In the Hamburg-cohort, mortality was 46% (42/92) for patients with a CV-event and 33% (27/83) for patients with only AMJ without CV-event (OR 1.7, CI: (0.94–3.2), p = 0.077). Mortality was higher in patients with CV-events (Odds ratio(OR): 4.8, 95%-confidence-interval(CI): [2.9–8]). Age (OR 1.1, CI: (0.66–1.86)), atrial fibrillation (AF) on baseline-ECG (OR 3.4, CI: (1.74–6.8)), systolic blood-pressure (OR 0.7, CI: (0.53–0.96)), potassium (OR 1.3, CI: (0.99–1.73)) and C-reactive-protein (1.4, CI (1.04–1.76)) were associated with CV-events. Conclusion: Hospitalized COVID-19 patients with clinical manifestation of acute cardiovascular events show an almost five-fold increased mortality. In this regard, the emergence of arrhythmias is a major determinant.

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Section: Cardiovascular Events and Troponinmentioning

confidence: 99%

Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study

Gunawardene

Geßler

Wohlmuth

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…Even if in normotensive patients the specificity and PPV of this biomarker are low, but with a high NPV, when interpreted in combination with clinical and imaging findings, they may improve the identification of an elevated PE-related risk [ 31 , 32 ]. Elevated hs-cTn levels are also a good prognostic marker in patients with congenital heart disease [ 33 ], infective endocarditis [ 34 ], acute pneumonia [ 35 ], atrial fibrillation (AF) [ 36 ], intracranial haemorrhage [ 37 ], and heart failure (HF) [ 38 ]. For example, in a study including 171 patients with acute pneumonia aged >75 years old, the elevation of cardiac troponin I was strongly associated with short-term mortality and a higher risk of in-hospital complications, suggesting that troponin measurement at admission for patients with acute pneumonia could help clinicians to individualise the CV prevention strategies in order to improve the short and long-term outcomes [ 35 ].…”

Section: Cardiac Troponins: From Promising To Gold Standardmentioning

confidence: 99%

High-Sensitivity Troponin: A Review on Characteristics, Assessment, and Clinical Implications

Lazar

Homorodean

et al. 2022

Disease Markers

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The use of high-sensitivity cardiac troponin (hs-cTn) assays has become part of the daily practice in most of the laboratories worldwide in the initial evaluation of the typical chest pain. Due to their early surge, the use of hs-cTn may reduce the time needed to recognise myocardial infarctions (MI), which is vital for the patients presenting in the emergency departments for chest pain. The latest European Society of Cardiology Guidelines did not only recognise their central role in the diagnosis algorithm but also recommended their use for rapid rule-in/rule-out of MI. High-sensitivity cardiac troponins are also powerful prognostic markers for long-term events and mortality, not only in a wide spectrum of other cardiovascular diseases (CVD) but also in several non-CVD pathologies. Moreover, these biomarkers became a powerful tool in special populations, such as paediatric patients and, most recently, COVID-19 patients. Although highly investigated, the assessment and interpretation of the hs-cTn changes are still challenging in the patients with basal elevation such as CKD or critically ill patients. Moreover, there are still various analytical characteristics not completely understood, such as circadian or sex variability, with major clinical implications. In this context, the present review focuses on summarizing the most recent research in the current use of hs-cTn, with a main consideration for its role in the diagnosis of MI but also its prognostic value. We have also carefully selected the most important studies regarding the challenges faced by clinicians from different specialties in the correct interpretation of this biomarker. Moreover, future perspectives have been proposed and analysed, as more research and cross-disciplinary collaboration are necessary to improve their performance.

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“…In patients admitted for respiratory failure COVID-related, myocardial injury does not necessarily indicate acute cardiac disease, such as acute coronary syndrome or heart failure, but is on the spectrum of a severe systemic condition [30][31][32]. Troponin measurement is a tool that allows an easy assessment of myocardial injury, and it is widely available and low cost and may provide important prognostic and clinical information in these patients.…”

Section: Assessment Of Cardiovascular Damage: How and Whenmentioning

confidence: 99%

Cardiovascular Damage in COVID-19: What We Know Two Years Later

et al. 2022

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Purpose of the Review The Coronavirus disease 2019 (COVID-19) pandemic has profoundly influenced cardiological clinical and basic research in the past two years. In the present review, we summarize the current knowledge on myocardial involvement in COVID-19, providing an overview on the incidence, the pathogenetic mechanisms, and the clinical implications of cardiac injury in this setting. Recent Findings The possibility of heart involvement in patients with COVID-19 has received great attention since the beginning of the pandemic. After more than two years, several steps have been taken in understanding the mechanisms and the incidence of cardiac injury during COVID-19 infection. Similarly, studies globally have clarified the implications of co-existing heart disease and COVID-19. Summary Severe COVID-19 infection may be complicated by myocardial injury. To date, a direct damage from the virus has not been demonstrated. The presence of myocardial injury should be systematically assessed for a prognostication purpose and for possible therapeutic implications.

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Troponin Elevation in Older Patients with Acute Pneumonia: Frequency and Prognostic Value

Cited by 10 publications

References 50 publications

Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study

Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study

High-Sensitivity Troponin: A Review on Characteristics, Assessment, and Clinical Implications

Cardiovascular Damage in COVID-19: What We Know Two Years Later

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