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Cardiac Damage in Patients Infected with Different SARS-CoV-2 Variants of Concern
Francesco Robert Burkert1, Martina Oberhollenzer1, Daniela Kresse1
1Department of Internal Medicine II, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
Insights
The Omicron variant of COVID-19 is associated with higher cardiac biomarker levels, specifically high-sensitivity Troponin-T and NT-proBNP, compared to the wild-type/Alpha variants. Despite increased cardiac involvement, in-hospital mortality rates were similar between the groups.
Area of Science:
- Cardiology
- Infectious Diseases
- Virology
Background:
- Coronavirus Disease 2019 (COVID-19) variants of concern (VOCs) exhibit differential impacts on organ systems.
- Previous studies have indicated potential cardiac involvement in COVID-19, but comparisons between distinct VOCs are limited.
Purpose of the Study:
- To compare cardiac biomarkers and clinical outcomes in hospitalized patients infected with wild-type/Alpha (wt/Alpha) VOC versus Omicron VOC.
- To investigate the association between cardiac biomarker levels and clinical outcomes across different COVID-19 VOCs.
Main Methods:
- A single-center retrospective cohort analysis was conducted.
- Hospitalized patients infected with wt/Alpha VOC (n=428) were compared to those infected with Omicron VOC (n=117).
- Maximal median high-sensitivity Troponin-T (hs-TnT) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels were analyzed.
Main Results:
- The Omicron cohort exhibited significantly higher maximal median hs-TnT (27.8 ng/L vs. 12.8 ng/L) and NT-proBNP (825 ng/L vs. 256 ng/L) levels compared to the wt/Alpha cohort (p < 0.001 for both).
- Elevated cardiac biomarkers were observed even in younger patients without pre-existing cardiovascular disease in the Omicron group.
- In-hospital mortality rates were similar (7.7% Omicron vs. 12.7% wt/Alpha; p = 0.132), but more wt/Alpha patients required intensive care admission (22.2% vs. 12%; p = 0.014).
Conclusions:
- Hospitalized patients infected with the Omicron VOC demonstrated significantly higher levels of cardiac biomarkers (hs-TnT, NT-proBNP) indicating greater cardiac involvement compared to wt/Alpha VOC.
- Despite increased cardiac biomarker levels in the Omicron cohort, in-hospital mortality was comparable between the two groups.
- Increased cardiac biomarkers correlated with higher risks of mortality and ICU admission in both wt/Alpha and Omicron infected patients.
Abstract:
Coronavirus Disease 2019 causes significant morbidity, and different variants of concern (VOCs) can impact organ systems differently. We conducted a single-center retrospective cohort analysis comparing biomarkers and clinical outcomes in hospitalized patients infected with the wild-type or Alpha (wt/Alpha) VOC against patients infected with the Omicron VOC. We included 428 patients infected with the wt/Alpha VOC and 117 patients infected with the Omicron VOC. The Omicron cohort had higher maximal median high-sensitivity Troponin-T (hs-TnT) levels (wt/Alpha: 12.8 ng/L, IQR 6.6-29.5 vs. Omicron: 27.8 ng/L, IQR 13.7-54.0; p < 0.001) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (wt/Alpha: 256 ng/L, IQR 74.5-913.5 vs. Omicron: 825 ng/L, IQR 168-2759; p < 0.001) levels. This remained true for patients under 65 years of age and without pre-existing cardiovascular disease (hs-TnT (wt/Alpha: 6.1 ng/L, IQR 2.5-10.25 vs. Omicron: 8.6 ng/L, IQR 6.2-15.7; p = 0.007) and NT-proBNP (wt/Alpha: 63 ng/L, IQR 25-223.75 vs. Omicron: 158 ng/L, IQR 75.5-299.5; p = 0.006)). In-hospital mortality was similar between the two groups (wt/Alpha: 53 or 12.7% vs. Omicron: 9 or 7.7%; p = 0.132) and more patients infected with wt/Alpha VOC required intensive care admission (wt/Alpha: 93 or 22.2% vs. Omicron: 14 or 12%; p = 0.014). Increased cardiac biomarkers were correlated with a higher risk of mortality and ICU admission in both groups. Herein, we detected higher levels of cardiac biomarkers in hospitalized patients infected with the Omicron VOC when compared to wt/Alpha, being indicative of higher cardiac involvement. Although hs-TnT and NT-proBNP levels were higher in the Omicron cohort and both markers were linked to in hospital mortality in both groups, the mortality rates were similar.
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