CHARACTERIZATION OF MYOCARDIAL INJURY IN A COHORT OF PATIENTS WITH SARS-CoV-2 INFECTION

ABSTRACT BACKGROUND: Myocardial injury has been identified as a common complication in patients with COVID-19 However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19 METHODS: Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied RESULTS: A total of 918 patients (mean age 63 2 ± 15 5 years, 60 1% male) with a median follow-up of 57 (49-63) days were included Of these, 190 (20 7%) fulfilled strict criteria for myocardial injury (21 1% chronic, 76 8% acute non-ischemic, 2 1% acute ischemic) Time from onset of symptoms to maximum hs-TnI was 11 (7-18) days Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury hs-TnI was identified as an independent predictor of mortality [HR 2 52 (1 57-4 04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates CONCLUSION: Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes RESUMEN ANTECEDENTES: El dano miocardico parece una complicacion frecuente en pacientes COVID-19 Sin embargo, la literatura al respecto presenta serias limitaciones, como definiciones incorrectas, heterogeneidad de las determinaciones de troponina o seguimientos cortos Utilizando datos de una cohorte amplia, el objetivo del trabajo fue caracterizar adecuadamente el dano miocardico en pacientes COVID-19 utilizando una metodologia adecuada METODOS: Se estudiaron pacientes consecutivos con infeccion confirmada y determinaciones disponibles de troponina I de alta sensibilidad (hs-TnI), desde el 1 de marzo al 20 de abril de 2020, que hubieran completado al menos 1 mes de seguimiento o fallecieran durante el periodo de estudio RESULTADOS: Se incluyeron 918 pacientes (edad 63 2 ± 15 5 anos, 60 1% varones) con un seguimiento mediano de 57 (49-63) dias De estos, 190 (20 7%) cumplian criterios estrictos de lesion miocardica (21 1% cronica, 76 8% aguda no isquemica, 2 1% aguda isquemica) El tiempo desde el inicio de los sintomas hasta la hs-TnI maxima fue de 11 (7-18) dias Los eventos tromboticos y hemorragicos, arritmias, insuficiencia cardiaca, necesidad de ventilacion mecanica y muerte fueron significativamente mas frecuentes en pacientes con concentraciones elevadas de hs-TnI, incluso por debajo del nivel de lesion miocardica La hs-TnI resulto un predictor independiente de mortalidad [HR 2 52 (1 57-4 04) por cada 5 unidades logaritmicas] CONCLUSIONES: La hs-TnI elevada es altamente prevalente entre los pacientes COVID-19 Elevaciones leves muy por debajo del limite para definir lesion miocardica se asociaron con mas complicaciones y mayor mortalidad La determinacion protocolizada de hs-TnI en estos enfermos podria mejorar su estratificacion pronostica y los resultados clinicos