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Published on: December 19, 2020
Characterization of Myocardial Injury in Patients With COVID-19
Gennaro Giustino1, Lori B Croft1, Giulio G Stefanini2
1The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York.
Insights
Myocardial injury is common in COVID-19 patients and linked to poor outcomes. Echocardiographic abnormalities in these patients significantly increase in-hospital mortality risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Myocardial injury is frequent in coronavirus disease-2019 (COVID-19) patients, correlating with poor prognosis.
- Mechanisms of COVID-19-related myocardial injury and associated cardiovascular imaging findings require further elucidation.
Purpose of the Study:
- To characterize echocardiographic abnormalities in COVID-19 patients with myocardial injury.
- To assess the prognostic impact of these echocardiographic findings on in-hospital mortality.
Main Methods:
- International, multicenter cohort study of 305 hospitalized COVID-19 patients.
- Transthoracic echocardiography (TTE) and electrocardiography were performed.
- Myocardial injury defined by elevated cardiac troponin.
Main Results:
- Myocardial injury occurred in 62.3% of patients.
- Patients with myocardial injury showed more ECG abnormalities, higher inflammatory markers, and increased echocardiographic abnormalities.
- In-hospital mortality rates were 5.2% (no injury), 18.6% (injury, no TTE abnormalities), and 31.7% (injury with TTE abnormalities).
Conclusions:
- Cardiac structural abnormalities were found in nearly two-thirds of COVID-19 patients with myocardial injury.
- Myocardial injury with echocardiographic abnormalities significantly increased in-hospital mortality risk.
Background:
Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data.
Objectives:
This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19.
Methods:
We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization.
Results:
A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities.
Conclusions:
Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.
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