Related Experiment Video
Updated: Dec 9, 2025
Real-time Pressure-volume Analysis of Acute Myocardial Infarction in Mice
Published on: July 2, 2018
Parameters predicting COVID-19-induced myocardial injury and mortality
G D Duerr1, A Heine2, M Hamiko1
1Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
Insights
Pericardial effusion (PE) in COVID-19 patients indicates severe cardiac injury and poor prognosis. A high CD8/Treg/monocyte ratio predicts critical illness, guiding risk assessment for better patient outcomes.
Area of Science:
- Cardiology
- Immunology
- Infectious Diseases
Background:
- COVID-19 frequently impacts the heart, with cardiovascular disease as a major comorbidity.
- Identifying prognostic factors for severe COVID-19 courses and understanding COVID-induced myocardial damage mechanisms are crucial.
- There is a need for reliable markers to predict critical illness in COVID-19 patients with cardiac involvement.
Purpose of the Study:
- To identify prognostic markers for severe COVID-19 disease courses.
- To investigate the role of pericardial effusion (PE) and immunological parameters in predicting cardiac injury and prognosis.
- To elucidate the immunomechanisms underlying COVID-19-induced myocardial damage.
Main Methods:
- Retrospective analysis of 19 COVID-19 patients, including clinical data, echocardiography (TTE), NMR, and flow cytometry (FACS).
- Assessment of pericardial effusion (PE) presence, cardiac function, myocardial injury markers (hs-TnT), and immune cell populations (CD8+, Tregs, monocytes).
- Correlation of immunological parameters (CD8/Treg/monocyte ratio) and clinical outcomes (APACHE-II score, mechanical ventilation, mortality).
Main Results:
- Patients with pericardial effusion (PE) were more likely to develop severe disease, require mechanical ventilation, and have higher mortality.
- Transthoracic echocardiography (TTE) detected impaired cardiac function in PE patients at admission, preceding troponin elevation.
- A high CD8/Treg/monocyte ratio in PE patients correlated with systemic inflammation, elevated antiviral cytokines, and predicted a severe disease course.
Conclusions:
- Pericardial effusion (PE) is a significant predictor of cardiac injury in COVID-19 patients.
- Transthoracic echocardiography (TTE) is recommended at admission for early risk stratification.
- Immunological markers, specifically the CD8/Treg/monocyte ratio, aid in assessing prognosis and identifying patients at high risk for severe COVID-19 outcomes.
Abstract:
Clinical manifestations of COVID-19 affect many organs, including the heart. Cardiovascular disease is a dominant comorbidity and prognostic factors predicting risk for critical courses are highly needed. Moreover, immunomechanisms underlying COVID-induced myocardial damage are poorly understood.
Objective:
To elucidate prognostic markers to identify patients at risk.
Results:
Only patients with pericardial effusion (PE) developed a severe disease course, and those who died could be identified by a high CD8/Treg/monocyte ratio. Ten out of 19 COVID-19 patients presented with PE, 7 (78%) of these had elevated APACHE-II mortality risk-score, requiring mechanical ventilation. At admission, PE patients showed signs of systemic and cardiac inflammation in NMR and impaired cardiac function as detected by transthoracic echocardiography (TTE), whereas parameters of myocardial injury e.g. high sensitive troponin-t (hs-TnT) were not yet increased. During the course of disease, hs-TnT rose in 8 of the PE-patients above 16 ng/l, 7 had to undergo ventilatory therapy and 4 of them died. FACS at admission showed in PE patients elevated frequencies of CD3+CD8+ T cells among all CD3+ T-cells, and lower frequencies of Tregs and CD14+HLA-DR+-monocytes. A high CD8/Treg/monocyte ratio predicted a severe disease course in PE patients, and was associated with high serum levels of antiviral cytokines. By contrast, patients without PE and PE patients with a low CD8/Treg/monocyte ratio neither had to be intubated, nor died.
Conclusions:
PE predicts cardiac injury in COVID-19 patients. Therefore, TTE should be performed at admission. Immunological parameters for dysfunctional antiviral immunity, such as the CD8/Treg/monocyte ratio used here, supports risk assessment by predicting poor prognosis.
More Related Videos
Related Concept Videos
01:21Myocarditis I: Introduction
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:14Myocarditis III: Medical Management
01:22Myocarditis IV: Nursing Management
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy