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SARS-CoV-2 and myocardial injury: Few answers, many questions

Paul C Cremer1

  • 1Department of Cardiovascular Imaging, Heart, Vascular, and Thoracic Institute, Cleveland Clinic cremerp@ccf.org.

Cleveland Clinic Journal of Medicine
|May 7, 2020
PubMed

Insights

Acute cardiac injury is common in COVID-19 patients and linked to worse outcomes. It often co-occurs with high inflammation, but optimal treatment strategies for these combined conditions remain unclear.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Acute cardiac injury (ACI) affects 10-35% of COVID-19 patients, varying by assay and population.
  • Mechanisms of SARS-CoV-2 myocardial injury are not fully understood; Type 1 myocardial infarction and myocarditis are rare.
  • ACI in COVID-19 often presents with elevated inflammatory markers, both associated with adverse outcomes.

Purpose of the Study:

  • To investigate the clinical significance of acute cardiac injury in COVID-19 patients.
  • To explore the relationship between acute cardiac injury, systemic inflammation, and patient outcomes.
  • To determine if distinct treatment approaches are needed for patients with ACI, heightened inflammation, or both.

Main Methods:

  • Observational study analyzing data from hospitalized COVID-19 patients.
  • Assessment of high-sensitivity troponin I or T levels upon admission and during hospitalization.
  • Correlation analysis of cardiac injury markers, inflammatory markers, and clinical outcomes.

Main Results:

  • Acute cardiac injury is a frequent complication in COVID-19.
  • Elevated inflammatory markers frequently coexist with acute cardiac injury in these patients.
  • Both acute cardiac injury and heightened inflammation are associated with poorer prognosis.

Conclusions:

  • Acute cardiac injury is prevalent in COVID-19 and linked to adverse outcomes.
  • The interplay between cardiac injury and systemic inflammation requires further investigation.
  • Optimal therapeutic strategies for COVID-19 patients with concurrent cardiac injury and inflammation are yet to be defined.

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