Use and Prognostic Implications of Cardiac Troponin in COVID-19

Michieli, Laura De; Jaffe, Allan S.; Sandoval, Yader

doi:10.1016/j.ccl.2022.03.005

Cited by 10 publications

(8 citation statements)

References 93 publications

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“…Although the virulence and pathogenicity of the Omicron variant appear to be lower than that of the Alpha or Delta variants that preceded it, the elevated occurrence of myocardial injury among the aging population infected with the Omicron variant cannot be ignored. Evidence from several studies suggests that myocardial injury is an independent risk factor for adverse outcomes in patients ( 17 ), and the occurrence of myocardial injury is positively correlated with both exacerbation and death ( 12 , 18 – 20 ). In our study, we found that a greater proportion of elderly patients with myocardial injury than those without had infections that became severe, requiring either non-invasive or invasive ventilatory respiratory support, and even transfer to intensive care.…”

Section: Discussionmentioning

confidence: 99%

A study of clinical and serological correlation of early myocardial injury in elderly patients infected with the Omicron variant

Yu,

Li,

Xia

et al. 2024

Front. Cardiovasc. Med.

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IntroductionMyocardial injury in elderly Omicron variant patients is a leading cause of severe disease and death. This study focuses on elucidating the clinical characteristics and potential risk factors associated with myocardial injury in elderly patients infected with the Omicron variant.MethodsMyocardial injury was defined based on elevated cardiac troponin concentrations exceeding the 99th percentile upper reference limit. Among 772 elderly Omicron-infected patients, categorized into myocardial injury (n = 263) and non-myocardial injury (n = 509) groups. The stratified log-rank statistic was used to compare the probability of patients developing intensive care. Receiver operating characteristic curves were used to determine the best cut-off values of clinical and laboratory data for predicting myocardial injury. Univariate and multivariate logistic regression was adopted to analyze the risk factors for myocardial injury.ResultsThe occurrence of myocardial injury in Omicron variant-infected geriatric patients was up to 34.07% and these patients may have a higher rate of requiring intensive care (P < 0.05). By comparing myocardial injury patients with non-myocardial injury patients, notable differences were observed in age, pre-existing medical conditions (e.g., hypertension, coronary heart disease, cerebrovascular disease, arrhythmia, chronic kidney disease, and heart failure), and various laboratory biomarkers, including cycle threshold-ORF1ab gene (Ct-ORF1ab), cycle threshold-N gene (Ct-N), white blood cell count, neutrophil (NEUT) count, NEUT%, lymphocyte (LYM) count, LYM%, and D-dimer, interleukin-6, procalcitonin, C-reactive protein, serum amyloid A, total protein, lactate dehydrogenase, aspartate aminotransferase, glomerular filtration rate, blood urea nitrogen, and serum creatinine (sCr) levels (P < 0.05). Furthermore, in the multivariable logistic regression, we identified potential risk factors for myocardial injury in Omicron variant–infected elderly patients, including advanced age, pre-existing coronary artery disease, interleukin-6 > 22.69 pg/ml, procalcitonin > 0.0435 ng/ml, D-dimer > 0.615 mg/L, and sCr > 81.30 μmol/L.ConclusionThis study revealed the clinical characteristics and potential risk factors associated with myocardial injury that enable early diagnosis of myocardial injury in Omicron variant-infected elderly patients, providing important reference indicators for early diagnosis and timely clinical intervention.

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Section: Discussionmentioning

confidence: 99%

A study of clinical and serological correlation of early myocardial injury in elderly patients infected with the Omicron variant

Yu,

Li,

Xia

et al. 2024

Front. Cardiovasc. Med.

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“…The incidence of myocardial injury increases with greater disease severity and ARDS occurrence [ 38 ]. However, for a significant number of COVID-19 patients, myocardial injury is chronic, and not directly related with COVID-19 [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The infection affects cardiac muscle integrity, fibrinogen pathways, redox homeostasis and induces a break in atheromatous plaques, which aggravates myocardial injury and dysfunction [ 8 ]. Myocardial injury is associated with a higher risk for adverse events in COVID-19 patients, and was described in over 50% of intensive care unit (ICU) patients and between 10% and 45% in hospitalized non-ICU patients [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Biomarkers and Risk Scores in Relation with History of Atherosclerotic Cardiovascular Disease in Patients Admitted with COVID-19: The Experience of an Eastern European Center

Lionte

Șorodoc

Haliga

et al. 2022

JCM

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Background: Data regarding the combined prognostic role of biomarkers and risk scores in relation with the history of atherosclerotic cardiovascular disease (ASCVD) in COVID-19 patients are lacking. Methods: The aim of this observational cohort study was to evaluate the combined prognostic value of N-terminal pro B-type natriuretic peptide (NT-pro BNP), troponin and risk scores in relation with ASCVD history in hospitalized COVID-19 patients. The primary composite endpoint was Intensive Care Unit (ICU) admission and death. Results: From April 2020 to June 2022, 1066 consecutive COVID-19 patients with available biomarkers upon admission were included. During a median follow-up period of 12 days, 176 patients (16.5%) died. Independent predictors of ICU admission and death in patients with ASCVD were NT-pro BNP (HR 2.63; 95% CI, 1.65–4.18) and troponin (HR 1.51; 95% CI, 1.13–2.03). In patients without ASCVD, only NT-pro BNP was predictive for the primary endpoint (HR 1.66; 95% CI, 1.10–2.53). This remained significant after adjustment for other relevant covariates (HR 3.54; 95% CI, 1.98–6.33) in patients with ASCVD and in patients without ASCVD (HR 1.82; 95% CI, 1.02–3.26). Conclusions: These data showed the combined prognostic accuracy of NT-pro BNP and troponin in relation with ASCVD history for ICU admission and death in COVID-19 patients.

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“…Acute cardiac injury (ACI) represents a significant complication of COVID-19 [2,3], correlating with increased susceptibility to disease severity [4] and mortality [5]. Cardiac muscle damage can either be inflicted by direct heart damage by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [6] or by a concurrent condition, such as respiratory failure, sepsis, and systemic inflammation, among others [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Elevated Troponins after COVID-19 Hospitalization and Long-Term COVID-19 Symptoms: Incidence, Prognosis, and Clinical Outcomes—Results from a Multi-Center International Prospective Registry (HOPE-2)

Vazirani,

Feltes,

Hoyo

et al. 2024

JCM

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Background: Acute cardiac injury (ACI) after COVID-19 has been linked with unfavorable clinical outcomes, but data on the clinical impact of elevated cardiac troponin on discharge during follow-up are scarce. Our objective is to elucidate the clinical outcome of patients with elevated troponin on discharge after surviving a COVID-19 hospitalization. Methods: We conducted an analysis in the prospective registry HOPE-2 (NCT04778020). Only patients discharged alive were selected for analysis, and all-cause death on follow-up was considered as the primary endpoint. As a secondary endpoint, we established any long-term COVID-19 symptoms. HOPE-2 stopped enrolling patients on 31 December 2021, with 9299 patients hospitalized with COVID-19, of which 1805 were deceased during the acute phase. Finally, 2382 patients alive on discharge underwent propensity score matching by relevant baseline variables in a 1:3 fashion, from 56 centers in 8 countries. Results: Patients with elevated troponin experienced significantly higher all-cause death during follow-up (log-rank = 27.23, p < 0.001), and had a higher chance of experiencing long-term COVID-19 cardiovascular symptoms. Specifically, fatigue and dyspnea (57.7% and 62.8%, with p-values of 0.009 and <0.001, respectively) are among the most common. Conclusions: After surviving the acute phase, patients with elevated troponin on discharge present increased mortality and long-term COVID-19 symptoms over time, which is clinically relevant in follow-up visits.

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Use and Prognostic Implications of Cardiac Troponin in COVID-19

Cited by 10 publications

References 93 publications

A study of clinical and serological correlation of early myocardial injury in elderly patients infected with the Omicron variant

A study of clinical and serological correlation of early myocardial injury in elderly patients infected with the Omicron variant

Cardiac Biomarkers and Risk Scores in Relation with History of Atherosclerotic Cardiovascular Disease in Patients Admitted with COVID-19: The Experience of an Eastern European Center

Elevated Troponins after COVID-19 Hospitalization and Long-Term COVID-19 Symptoms: Incidence, Prognosis, and Clinical Outcomes—Results from a Multi-Center International Prospective Registry (HOPE-2)

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