Myocardial Injury in Adults Hospitalized With COVID-19

Smilowitz, Nathaniel R.; Jethani, Neil; Ji, Chen; Aphinyanaphongs, Yindalon; Zhang, Ruina; Dogra, Siddhant; Alviar, Carlos L.; Keller, Norma; Razzouk, Louai; Quinones-Camacho, Adriana; Jung, Albert; Fishman, Glenn I.; Hochman, Judith S.; Berger, Jeffrey S.

doi:10.1161/circulationaha.120.050434

Cited by 36 publications

(42 citation statements)

References 5 publications

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“…In hospitalized patients with COVID-19, the prevalence of elevated hs-TnT (high-sensitivity troponin-T) is 20% to 30%. 5 , 88 Inferred from such elevated cTn levels, acute myocardial injury reportedly ranges from 8% to 62% overall, 2 , 3 with worse disease severity associated with a higher prevalence of elevated levels. Elevated cTn levels were rare in COVID-19 survivors with an uncomplicated course (1%–20%), common in severely ill patients (46%–100%), and nearly universal in the critically ill (ie, requiring intensive care or mechanical ventilation) and nonsurvivors.…”

Section: Direct Myocardial Effectsmentioning

confidence: 99%

COVID-19 and Cardiovascular Disease

Chung

Zidar

Bristow

et al. 2021

Circulation Research

293

266

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A pandemic of historic impact, coronavirus disease 2019 (COVID-19) has potential consequences on the cardiovascular health of millions of people who survive infection worldwide. Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, can infect the heart, vascular tissues, and circulating cells through ACE2 (angiotensin-converting enzyme 2), the host cell receptor for the viral spike protein. Acute cardiac injury is a common extrapulmonary manifestation of COVID-19 with potential chronic consequences. This update provides a review of the clinical manifestations of cardiovascular involvement, potential direct SARS-CoV-2 and indirect immune response mechanisms impacting the cardiovascular system, and implications for the management of patients after recovery from acute COVID-19 infection.

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Section: Direct Myocardial Effectsmentioning

confidence: 99%

COVID-19 and Cardiovascular Disease

Chung

Zidar

Bristow

et al. 2021

Circulation Research

293

266

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“…Our data also strongly underline the prognostic value of hs-cTnI for prediction of short-term mortality in COVID-19, which is in line with previous research data, that have identified myocardial injury as powerful prognostic marker in COVID-19. 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.…”

Section: Clinical Evidencementioning

confidence: 99%

“…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%

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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“…Later, Lombardi and colleagues validated these findings in a multi-center cohort in Italy with over 600 patients, albeit with a more attenuated hazard ratio of 1.7 [ 25 ]. In one of the most diverse cohorts studied with over 2000 patients admitted to a New York City hospital system, Smilowitz and colleagues illustrated that the risk of death was twofold higher among patients with troponin elevation [ 46 ]. Importantly, the degree of troponin elevation was associated with more severe critical illness (defined as ICU admission, need for mechanical ventilation, discharge to hospice, or death).…”

Section: Part I: Acute Infectionmentioning

confidence: 99%

COVID and Cardiovascular Disease: What We Know in 2021

Chilazi

Duffy

Thakkar

et al. 2021

Curr Atheroscler Rep

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Purpose of Review Coronavirus disease 2019 (COVID-19) has been the cause of significant global morbidity and mortality. Here, we review the literature to date of the short-term and long-term consequences of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection on the heart. Recent Findings Early case reports described a spectrum of cardiovascular manifestations of COVID-19, including myocarditis, stress cardiomyopathy, myocardial infarction, and arrhythmia. However, in most cases, myocardial injury in COVID-19 appears to be predominantly mediated by the severity of critical illness rather than direct injury to myocardium from viral particles. While cardiac magnetic resonance imaging remains a powerful tool for diagnosing acute myocarditis, it should be used judiciously in light of low baseline prevalence of myocarditis. Guiding an athletic patient through return to play (RTP) after COVID-19 infection is a challenging process. More recent data show RTP has been a safe endeavor using a screening protocol. “Long COVID” or post-acute sequelae of SARS-CoV-2 infection has also been described. The reported symptoms span a large breadth of cardiopulmonary and neurologic complaints including fatigue, palpitations, chest pain, breathlessness, brain fog, and dysautonomia including postural tachycardia syndrome (POTS). Management of POTS/dysautonomia primarily centers on education, exercise, and salt and fluid repletion. Summary Our understanding of the impact of COVID-19 on the cardiovascular system is constantly evolving. As we enter a new age of survivorship, additional research is needed to catalogue the burden of persistent cardiopulmonary symptoms. Research is also needed to learn how acute management may alter the likelihood and prevalence of this chronic syndrome.

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Myocardial Injury in Adults Hospitalized With COVID-19

Cited by 36 publications

References 5 publications

COVID-19 and Cardiovascular Disease

COVID-19 and Cardiovascular Disease

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

COVID and Cardiovascular Disease: What We Know in 2021

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