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Cardiovascular biomarkers in patients with COVID-19
Christian Mueller1, Evangelos Giannitsis2, Allan S Jaffe3
1Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
Insights
Cardiovascular biomarkers like troponin, natriuretic peptides, and D-dimers aid in assessing COVID-19 severity and patient risk. These markers help evaluate cardiac injury, stress, and coagulation, guiding treatment for pneumonia and related complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic highlighted potential cardiovascular impacts of SARS-CoV-2 infection.
- Patients with pre-existing cardiac conditions are often more severely affected by COVID-19.
- Uncertainty exists regarding the optimal use and interpretation of cardiovascular biomarkers in COVID-19 patients.
Purpose of the Study:
- To clarify the prognostic value and interpretation of cardiovascular biomarkers in COVID-19 patients.
- To guide clinicians on utilizing cardiac troponin, natriuretic peptides, and D-dimers for risk stratification.
- To compare the role of these biomarkers in COVID-19 with their role in general pneumonia and ARDS.
Main Methods:
- Review of recent findings on cardiovascular biomarkers in hospitalized COVID-19 patients.
- Analysis of biomarker correlations with disease severity, cardiac involvement, and mortality.
- Comparison of biomarker patterns in COVID-19 with those in other pneumonias and ARDS.
Main Results:
- Cardiac troponin and natriuretic peptide levels correlate with COVID-19 severity and mortality, reflecting cardiomyocyte injury and cardiac stress.
- Elevated D-dimer levels indicate prominent activated coagulation in COVID-19, suggesting a role in endothelitis and VTE.
- Biomarker interpretation aids risk stratification for acute myocardial infarction, acute heart failure, and venous thromboembolism.
Conclusions:
- Cardiovascular biomarkers are valuable for assessing disease severity, cardiac involvement, and mortality risk in COVID-19.
- Quantitative interpretation of troponin and natriuretic peptides aids risk stratification and maintains diagnostic accuracy for AMI and AHF.
- Serial D-dimer measurements can guide VTE management and anticoagulation intensity in COVID-19 patients.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic has increased awareness that severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2) may have profound effects on the cardiovascular system. COVID-19 often affects patients with pre-existing cardiac disease, and may trigger acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE), acute myocardial infarction (AMI), and acute heart failure (AHF). However, as COVID-19 is primarily a respiratory infectious disease, there remain substantial uncertainty and controversy whether and how cardiovascular biomarkers should be used in patients with suspected COVID-19. To help clinicians understand the possible value as well as the most appropriate interpretation of cardiovascular biomarkers in COVID-19, it is important to highlight that recent findings regarding the prognostic role of cardiovascular biomarkers in patients hospitalized with COVID-19 are similar to those obtained in studies for pneumonia and ARDS in general. Cardiovascular biomarkers reflecting pathophysiological processes involved in COVID-19/pneumonia and its complications have a role evaluating disease severity, cardiac involvement, and risk of death in COVID-19 as well as in pneumonias caused by other pathogens. First, cardiomyocyte injury, as quantified by cardiac troponin concentrations, and haemodynamic cardiac stress, as quantified by natriuretic peptide concentrations, may occur in COVID-19 as in other pneumonias. The level of those biomarkers correlates with disease severity and mortality. Interpretation of cardiac troponin and natriuretic peptide concentrations as quantitative variables may aid in risk stratification in COVID-19/pneumonia and also will ensure that these biomarkers maintain high diagnostic accuracy for AMI and AHF. Second, activated coagulation as quantified by D-dimers seems more prominent in COVID-19 as in other pneumonias. Due to the central role of endothelitis and VTE in COVID-19, serial measurements of D-dimers may help physicians in the selection of patients for VTE imaging and the intensification of the level of anticoagulation from prophylactic to slightly higher or even therapeutic doses.
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