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Acute myocardial injury is common in patients with COVID-19 and impairs their prognosis.

ABSTRACT: OBJECTIVE:We sought to explore the prevalence and immediate clinical implications of acute myocardial injury in a cohort of patients with COVID-19 in a region of China where medical resources are less stressed than in Wuhan (the epicentre of the pandemic). METHODS:We prospectively assessed the medical records, laboratory results, chest CT images and use of medication in a cohort of patients presenting to two designated covid-19 treatment centres in Sichuan, China. Outcomes of interest included death, admission to an intensive care unit (ICU), need for mechanical ventilation, treatment with vasoactive agents and classification of disease severity. Acute myocardial injury was defined by a value of high-sensitivity troponin T (hs-TnT) greater than the normal upper limit. RESULTS:A total of 101 cases were enrolled from January to 10 March 2020 (average age 49 years, IQR 34-62 years). Acute myocardial injury was present in 15.8% of patients, nearly half of whom had a hs-TnT value fivefold greater than the normal upper limit. Patients with acute myocardial injury were older, with a higher prevalence of pre-existing cardiovascular disease and more likely to require ICU admission (62.5% vs 24.7%, p=0.003), mechanical ventilation (43.5% vs 4.7%, p<0.001) and treatment with vasoactive agents (31.2% vs 0%, p<0.001). Log hs-TnT was associated with disease severity (OR 6.63, 95% CI 2.24 to 19.65), and all of the three deaths occurred in patients with acute myocardial injury. CONCLUSION:Acute myocardial injury is common in patients with COVID-19 and is associated with adverse prognosis.

SUBMITTER: Wei JF

PROVIDER: S-EPMC7398466 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Acute myocardial injury is common in patients with COVID-19 and impairs their prognosis.

Wei Jia-Fu JF Huang Fang-Yang FY Xiong Tian-Yuan TY Liu Qi Q Chen Hong H Wang Hui H Huang He H Luo Yi-Chun YC Zhou Xuan X Liu Zhi-Yue ZY Peng Yong Y Xu Yuan-Ning YN Wang Bo B Yang Ying-Ying YY Liang Zong-An ZA Lei Xue-Zhong XZ Ge Yang Y Yang Ming M Zhang Ling L Zeng Ming-Quan MQ Yu He H Liu Kai K Jia Yu-Heng YH Prendergast Bernard D BD Li Wei-Min WM Chen Mao M

Heart (British Cardiac Society) 20200430 15

<h4>Objective</h4>We sought to explore the prevalence and immediate clinical implications of acute myocardial injury in a cohort of patients with COVID-19 in a region of China where medical resources are less stressed than in Wuhan (the epicentre of the pandemic).<h4>Methods</h4>We prospectively assessed the medical records, laboratory results, chest CT images and use of medication in a cohort of patients presenting to two designated covid-19 treatment centres in Sichuan, China. Outcomes of inte ...[more]

PMID: 32354798

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Project description:BackgroundMyocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data.ObjectivesThis study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19.MethodsWe conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization.ResultsA total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities.ConclusionsAmong patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.

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Acute myocardial injury is common in patients with COVID-19 and impairs their prognosis.

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Acute myocardial injury is common in patients with COVID-19 and impairs their prognosis.

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