Elevated high-sensitivity troponin is associated with subclinical cardiac dysfunction in patients recovered from
Hiromasa Hayama1,2, Satoshi Ide3, Masao Moroi1,2
1Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan.
Insights
Myocardial damage in COVID-19 survivors can be detected using high-sensitivity troponin levels (hsTnT) and echocardiography. Elevated hsTnT is linked to reduced left ventricular global longitudinal strain (LVGLS), indicating potential heart injury post-infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Coronavirus disease 2019 (COVID-19) can lead to myocardial injury.
- Assessing cardiac function in recovered patients is crucial for long-term health.
- High-sensitivity troponin (hsTnT) and echocardiography are key diagnostic tools for heart health.
Purpose of the Study:
- To investigate myocardial damage in recovered COVID-19 patients.
- To evaluate the association between high-sensitivity troponin levels (hsTnT) and echocardiographic parameters.
- To determine the utility of hsTnT and echocardiography in detecting cardiac injury post-COVID-19.
Main Methods:
- A single-center cohort study involving 209 recovered COVID-19 patients in Japan.
- Collection of demographic data, hsTnT levels, and echocardiography measurements.
- Analysis of ejection fraction, left ventricular global longitudinal strain (LVGLS), and right ventricular free-wall longitudinal strain (RVFWLS).
Main Results:
- Elevated hsTnT levels (≥ 3 pg/mL) were observed in 64.6% of patients.
- Reduced LVGLS was found in 29.7% of patients and was significantly associated with elevated hsTnT.
- Elevated hsTnT was an independent predictor of reduced LVGLS, even at levels slightly above detection sensitivity.
Conclusions:
- Even slight elevations in hsTnT above detection sensitivity correlate with decreased LVGLS in recovered COVID-19 patients.
- hsTnT and echocardiography are valuable tools for identifying myocardial injury in the post-COVID-19 recovery phase.
- These findings highlight the importance of cardiac monitoring in patients recovering from COVID-19.
Abstract:
The aim of this study is to investigate myocardial damage in recovering coronavirus disease 2019 (COVID-19) patients with high-sensitivity troponin levels (hsTnT) and echocardiography. In this single-center cohort study, 215 COVID-19 recovered patients were recruited from all over Japan between April and September 2020. Demographic characteristics, hsTnT levels, and echocardiography data were collected for 209 patients, after excluding those without serum samples or good-quality echocardiographic images. The mean (± standard deviation) age was 44 (± 12) years (range: 36-55 years), and 50.7% of the patients were males. The median time interval (interquartile range) from COVID-19 onset to post-recovery examination was 56 days (34-96 days). Seventy-four recovered patients (35.4%) had hsTnT less than detection sensitivity (< 3 pg/mL) and 135 recovered patients (64.6%) had hsTnT ≥ 3 pg/mL. Ejection fraction was more than 50% in all cases. Left ventricular global longitudinal strain (LVGLS) and right ventricular free-wall longitudinal strain (RVFWLS) were reduced in 62 (29.7%) and 8 patients (3.8%), respectively. They were significantly associated with elevated hsTnT levels. In cases with hsTnT above 5 pg/mL, the LVGLS was greatly reduced to 19.0 ± 2.2% (p < 0.001). Multivariate linear regression analysis showed that elevated hsTnT level was an independent predictor of reduced LVGLS (standardized β = -0.34; p < 0.001). In recovered COVID-19 patients, even a slight increase in hsTnT above detection sensitivity was associated with decreased LVGLS. hsTnT and echocardiography may be useful tools to detect myocardial injury in recovered COVID-19 patients.
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