Coronavirus disease 2019 in patients with cardiovascular disease: clinical features and implications on cardiac biomarkers assessment.
2021
INTRODUCTION: Previous cardiovascular disease (CVD) and myocardial involvement are common in coronavirus disease-19 (COVID-19). We investigated relationships between CVD, cardiac biomarkers and outcome in COVID-19. METHODS: We analyzed nâ=â252 patients from a multicenter study and provided comparison according to the presence or absence of underlying CVD. Cardiac biomarkers high-sensitivity Troponin [upper reference of normality (URN) 35âpg/ml for Troponin I and 14âpg/ml for Troponin T] and natriuretic peptides (Nt-pro-B-type natriuretic peptide, URN 300âpg/ml and B-type natriuretic peptide, URN 100âpg/ml) were both available in nâ=â136. RESULTS: Mean age was 69â±â16âyears (56% men, 31% with previous CVD). Raised hs-Troponin and natriuretic peptides were detected in 36 and 50% of the cases respectively. Age, chronic obstructive pulmonary disease, hemoglobin, hs-Troponin and natriuretic peptides were independently associated with underlying CVD (Pâ<â0.05 for all). Compared with the normal biomarkers subgroups, patients with isolated hs-Troponin elevation had higher in-hospital mortality (31 vs. 4%, Pâ<â0.05), similar CVD prevalence (15 vs. 11%) and trend towards higher D-dimer (930 vs. 397âng/ml, Pâ=â0.140). Patients with both biomarkers elevated had higher age, D-dimer, CVD and in-hospital mortality prevalence compared with other subgroups (all Pâ<â0.05 for trend). Outcome analysis revealed previous CVD [model 1: OR 2.72 (95% CI 1.14-6.49), Pâ=â0.024. model 2: OR 2.65 (95% CI 1.05-6.71), Pâ=â0.039], hs-Troponin (log10) [OR 2.61 (95% CI 1.21-5.66), Pâ=â0.015] and natriuretic peptides (log10) [OR 5.84 (95%CI 2.43-14), Pâ<â0.001] to be independently associated with in-hospital mortality. CONCLUSION: In our population, previous CVD was part of a vulnerable phenotype including older age, comorbidities, increased cardiac biomarkers and worse prognosis. Patients with isolated increase in hs-Troponin suffered higher mortality rates despite low prevalence of CVD, possibly explained by higher COVID-19-related systemic involvement.
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