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Cardiac Injury and Outcomes of Patients With COVID-19 in New York City
Tetsuro Maeda1, Reiichiro Obata1, Dahlia Rizk1
1Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, NY, USA.
Insights
Elevated troponin in COVID-19 patients indicates cardiac injury and is linked to higher in-hospital mortality, even without typical ECG changes. This cardiac injury is an independent predictor of mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Elevated troponin levels in COVID-19 patients correlate with increased in-hospital mortality.
- The relationship between cardiac injury, electrocardiogram (ECG) abnormalities, and mortality in COVID-19 patients requires further investigation.
Purpose of the Study:
- To examine the association between cardiac injury (elevated troponin I) and ECG abnormalities in hospitalized COVID-19 patients.
- To determine if cardiac injury is an independent predictor of in-hospital mortality in this population.
Main Methods:
- Retrospective cohort study of 181 patients hospitalized with COVID-19.
- Patients were categorized into cardiac injury (elevated troponin I) and no cardiac injury groups.
- Multivariate logistic regression analysis was used to identify predictors of in-hospital mortality.
Main Results:
- The cardiac injury group (n=54) showed higher rates of older age, cardiovascular comorbidities, and elevated inflammatory markers.
- While numerically more frequent, ECG abnormalities like T wave inversion and ST depression were not statistically significant between groups.
- In-hospital mortality was significantly higher in the cardiac injury group (42.3%) compared to the no cardiac injury group (12.6%).
- Cardiac injury (OR 3.25) and age were independent predictors of in-hospital mortality.
Conclusions:
- Hospitalized COVID-19 patients with elevated troponin I often present with minimal chest pain and infrequent ECG abnormalities.
- Cardiac injury, indicated by elevated troponin I, is a significant independent predictor of in-hospital mortality in COVID-19 patients.
Background:
Prior studies demonstrated that elevated troponin in patients with COVID-19 was associated with increased in-hospital mortality. However, the association of cardiac injury and electrocardiogram (ECG) changes remains unclear. The aim of this study was to investigate the association of cardiac injury with ECG abnormality and with in-hospital mortality.
Methods:
We conducted a retrospective cohort study of patients who were hospitalised with COVID-19 between 13 March and 31 March 2020. Those patients with troponin I measurement were included in the study and divided into those who had elevated troponin I (cardiac injury group) and those who did not (no cardiac injury group). Statistical analyses were performed to compare differences between the groups, and a multivariate logistic regression model was constructed to assess the effect of cardiac injury on in-hospital mortality.
Results:
One hundred and eight-one (181) patients were included, 54 of whom were in the cardiac injury group and 127 in the no cardiac injury group. The mean age was 64.0±16.6 years and 55.8% were male. The cardiac injury group was more likely to be older, have a history of coronary artery disease, atrial fibrillation and congestive heart failure compared to the no cardiac injury group (all p<0.05); there was no difference in presence of chest pain (cardiac injury group versus no cardiac injury group: 17.0% versus 22.5%, p=0.92); the cardiac injury group had a significantly higher value of brain natriuretic peptide, procalcitonin, interleukin-6 and D-dimer (all p<0.05); they had numerically more frequent ECG abnormalities such as T wave inversion (13.2% versus 7.5%, p=0.23) and ST depression (1.9% versus 0.0%, p=0.13) although statistically not significant; they had significantly higher in-hospital mortality (42.3% versus 12.6%, p<0.001). With a multivariate logistic regression model, age (odds ratio [95% confidence interval]: 1.033 [1.002-1.065], p=0.034) and cardiac injury (3.25 [1.40-7.54], p=0.006) were independent predictors of in-hospital mortality.
Conclusions:
Patients with COVID-19 with elevated troponin I had a relatively low proportion of chest pain and ECG abnormality. Cardiac injury was independently associated with in-hospital mortality.
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