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Troponin T in COVID-19 hospitalized patients: Kinetics matter
Affiliations- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, (Centrum voor Hart- en Vaatziekten), Brussels, Belgium
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussell, , Belgium, Brussels, Belgium
- Department of Nephrology, University Hospital of Ambroise Pare, Mons, Belgium
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Abstract
Background: Coronavirus disease 2019 (COVID-19) emerged as a worldwide health crisis, overwhelming healthcare systems. Elevated cardiac troponin T (cTn T) at admission was associated with increased in-hospital mortality. However, data addressing the role of cTn T in major adverse cardiovascular events (MACE) in COVID-19 are scarce. Therefore, we assessed the role of baseline cTn T and cTn T kinetics for MACE and in-hospital mortality prediction in COVID-19.
Methods: Three hundred and ten patients were included prospectively. One hundred and eight patients were excluded due to incomplete records. Patients were divided into three groups according to cTn T kinetics: ascending, descending, and constant. The cTn T slope was defined as the ratio of the cTn T change over time. The primary and secondary endpoints were MACE and in-hospital mortality.
Results: Two hundred and two patients were included in the analysis (mean age 64.4 ± 16.7 years, 119 [58.9%] males). Mean duration of hospitalization was 14.0 ± 12.3 days. Sixty (29.7%) patients had MACE, and 40 (19.8%) patients died. Baseline cTn T predicted both endpoints (p = 0.047, hazard ratio [HR] 1.805, 95% confidence interval [CI] 1.009–3.231; p = 0.009, HR 2.322, 95% CI 1.234–4.369). Increased cTn T slope predicted mortality (p = 0.041, HR 1.006, 95% CI 1.000–1.011). Constant cTn T was associated with lower MACE and mortality (p = 0.000, HR 3.080, 95% CI 1.914–4.954, p = 0.000, HR 2.851, 95% CI 1.828–4.447).
Conclusions: The present study emphasizes the additional role of cTn T testing in COVID-19 patients for risk stratification and improved diagnostic pathway and management.
Abstract
Background: Coronavirus disease 2019 (COVID-19) emerged as a worldwide health crisis, overwhelming healthcare systems. Elevated cardiac troponin T (cTn T) at admission was associated with increased in-hospital mortality. However, data addressing the role of cTn T in major adverse cardiovascular events (MACE) in COVID-19 are scarce. Therefore, we assessed the role of baseline cTn T and cTn T kinetics for MACE and in-hospital mortality prediction in COVID-19.
Methods: Three hundred and ten patients were included prospectively. One hundred and eight patients were excluded due to incomplete records. Patients were divided into three groups according to cTn T kinetics: ascending, descending, and constant. The cTn T slope was defined as the ratio of the cTn T change over time. The primary and secondary endpoints were MACE and in-hospital mortality.
Results: Two hundred and two patients were included in the analysis (mean age 64.4 ± 16.7 years, 119 [58.9%] males). Mean duration of hospitalization was 14.0 ± 12.3 days. Sixty (29.7%) patients had MACE, and 40 (19.8%) patients died. Baseline cTn T predicted both endpoints (p = 0.047, hazard ratio [HR] 1.805, 95% confidence interval [CI] 1.009–3.231; p = 0.009, HR 2.322, 95% CI 1.234–4.369). Increased cTn T slope predicted mortality (p = 0.041, HR 1.006, 95% CI 1.000–1.011). Constant cTn T was associated with lower MACE and mortality (p = 0.000, HR 3.080, 95% CI 1.914–4.954, p = 0.000, HR 2.851, 95% CI 1.828–4.447).
Conclusions: The present study emphasizes the additional role of cTn T testing in COVID-19 patients for risk stratification and improved diagnostic pathway and management.
Keywords
myocardial injury, cardiac troponin, kinetics, mortality, COVID-19, major cardiovascular adverse events
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About this articleTitle
Troponin T in COVID-19 hospitalized patients: Kinetics matter
Journal
Issue
Article type
Original Article
Pages
807-815
Published online
2021-09-23
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6488
Article views/downloads
651
DOI
Pubmed
Bibliographic record
Cardiol J 2021;28(6):807-815.
Keywords
myocardial injury
cardiac troponin
kinetics
mortality
COVID-19
major cardiovascular adverse events
Authors
Maria-Luiza Luchian
Andreea Iulia Motoc
Stijn Lochy
Julien Magne
Bram Roosens
Dries Belsack
Karen Van den Bussche
Berlinde von Kemp
Xavier Galloo
Clara François
Esther Scheirlynck
Sven Boeckstaens
Tom De Potter
Lucie Seyler
Johan van Laethem
Sophie Hennebicq
Caroline Weytjens
Steven Droogmans
Bernard Cosyns
References (30)- WHO, Aylward, Bruce (WHO); Liang W (PRC). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). WHO-China Jt Mission Coronavirus Dis 2019. 2020.
- Shi S, Qin Mu, Shen Bo, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020; 5(7): 802–810.
- Shi S, Qin Mu, Cai Y, et al. Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019. Eur Heart J. 2020; 41(22): 2070–2079.
- Kuno T, Takahashi M, Obata R, et al. Cardiovascular comorbidities, cardiac injury, and prognosis of COVID-19 in New York City. Am Heart J. 2020; 226: 24–25.
- Guan Wj, Liang Wh, Zhao Yi, et al. Comorbidity and its impact on 1,590 patients with COVID-19 in China: A Nationwide Analysis. Eur Respir J. 2020.
- Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiology. 2020; 5(7): 811.
- Sabatino J, De Rosa S, Di Salvo G, et al. Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis. PLoS One. 2020; 15(8): e0237131.
- Lala A, Johnson KW, Januzzi JL, et al. Prevalence and Impact of Myocardial Injury in Patients Hospitalized with COVID-19 Infection. medRxiv. 2020; 76(5): 533–546.
- Sandoval Y, Januzzi JL, Jaffe AS. Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week. J Am Coll Cardiol. 2020; 76(10): 1244–1258.
- Lorente-Ros A, Monteagudo Ruiz JM, Rincón LM, et al. Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients. Cardiol J. 2020; 27(5): 489–496.
- Collet JP, Thiele H. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020; 41(37): 3495–3497.
- Meguro S, Ishibashi M, Takei I. [The significance of high sensitive C reactive protein as a risk factor for cardiovascular diseases]. Rinsho Byori. 2012; 60(4): 356–361.
- Yancy C, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Cardiac Failure. 2017; 23(8): 628–651.
- Konstantinides SV, Meyer G, Becattini C, et al. ESC Scientific Document Group, The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2020; 41(4): 543–603.
- Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for themanagement of patients with supraventricular tachycardia. Eur Heart J. 2020; 41(5): 655–720.
- Majure DT, Gruberg L, Saba SG, et al. Usefulness of elevated troponin to predict death in patients with COVID-19 and myocardial injury. Am J Cardiol. 2021; 138: 100–106.
- Xu H, Hou K, Xu R, et al. Clinical characteristics and risk factors of cardiac involvement in COVID-19. J Am Heart Assoc. 2020; 9(18): e016807.
- Raad M, Dabbagh M, Gorgis S, et al. Cardiac injury patterns and inpatient outcomes among patients admitted with COVID-19. Am J Cardiol. 2020; 133: 154–161.
- Núñez-Gil IJ, Fernández-Ortiz A, Maroud Eid C, et al. Underlying heart diseases and acute COVID-19 outcomes. Cardiol J. 2021; 28(2): 202–214.
- Deng Q, Hu Bo, Zhang Y, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. 2020; 311: 116–121.
- Mueller C, Giannitsis E, Jaffe AS, et al. Cardiovascular biomarkers in patients with COVID-19. Eur Heart J Acute Cardiovasc Care. 2021; 10(3): 310–319.
- Chow EJ, Rolfes MA, O'Halloran A, et al. Acute cardiovascular events associated with influenza in hospitalized adults: a cross-sectional study. Ann Intern Med. 2020; 173(8): 605–613.
- Pesaresi M, Pirani F, Tagliabracci A, et al. SARS-CoV-2 identification in lungs, heart and kidney specimens by transmission and scanning electron microscopy. Eur Rev Med Pharmacol Sci. 2020; 24(9): 5186–5188.
- Giustino G, Croft L, Stefanini G, et al. Characterization of myocardial injury in patients with COVID-19. J Am Coll Cardiol. 2020; 76(18): 2043–2055.
- Li JJ, Fang CH. C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular diseases. Med Hypotheses. 2004; 62(4): 499–506.
- Park JE, Jung S, Kim A, et al. MERS transmission and risk factors: a systematic review. BMC Public Health. 2018; 18(1): 574.
- Cosyns B, Lochy S, Luchian ML, et al. The role of cardiovascular imaging for myocardial injury in hospitalized COVID-19 patients. Eur Heart J Cardiovasc Imaging. 2020; 21(7): 709–714.
- Mahajan VS, Jarolim P. How to interpret elevated cardiac troponin levels. Circulation. 2011; 124(21): 2350–2354.
- Li X, Guan Bo, Su T, et al. Impact of cardiovascular disease and cardiac injury on in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis. Heart. 2020; 106(15): 1142–1147.
- Skulstad H, Cosyns B, Popescu BA, et al. COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel. Eur Heart J Cardiovasc Imaging. 2020; 21(6): 592–598.
