Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection
Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort...
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| Veröffentlicht in: | Medicina clinica 2021-09, Vol.157 (6), p.274-280 |
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| creator | Caro-Codón, Juan Rey, Juan R. Buño, Antonio Iniesta, Angel M. Rosillo, Sandra O. Castrejon-Castrejon, Sergio Merino, Carlos Marco, Irene Martinez, Luis A. Garcia-Veas, Jose M. Martin-Polo, Lorena Rodriguez-Sotelo, Laura Martinez-Cossiani, Marcel Gonzalez-Valle, Luis Herrero, Alicia López-de-Sá, Esteban Merino, Jose L. |
| description | Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19.
Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied.
A total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49–63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7–18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57–4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates.
Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.
El daño miocárdico parece una complicación frecuente en pacientes con COVID-19. Sin embargo, la literatura al respecto presenta serias limitaciones, como definiciones incorrectas, heterogeneidad de las determinaciones de troponina o seguimientos cortos. Utilizando datos de una cohorte amplia, el objetivo del trabajo fue caracterizar adecuadamente el daño miocárdico en pacientes con COVID-19 utilizando una metodología adecuada.
Se estudió a pacientes consecutivos con infección confirmada y determinaciones disponibles de troponina I de alta sensibilidad (hs-TnI), desde el 1 de marzo hasta el 20 de abril del 2020, que hubieran completado al menos un mes de seguimiento o fallecieran durante el periodo de estudio.
Se incluyó a 918 pacientes (edad 63,2±15,5 años, 60,1% varones) con un seguim |
| doi_str_mv | 10.1016/j.medcli.2021.02.001 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_elsev</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7988449</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0025775321000920</els_id><sourcerecordid>33846001</sourcerecordid><originalsourceid>FETCH-LOGICAL-c463t-6653038c3d2f193023b4c2ce750d10d2482da8f2ce92111b4fce4f27840c106b3</originalsourceid><addsrcrecordid>eNqNkV1r2zAUhsVoWdKs_2AU3xd7Rx-2pZtCMN06CAzWdr0Usiw1CokVZCch-_WTlyxrb0qvjj6e90h6hNBnDBkGXHxZZCvT6KXLCBCcAckA8Ac0xnnJUy64OENjAJKnZZnTEbrousUwpbj8iEaUclZEfoyeqrkKSvcmuN-qd75NvE1We69VaJxaJq5dbMI-lkQl2s996AdgHVHT9l2yc_08uZ_-vE8r_yslkbNGD20-oXOrlp25PNYJevx6-1DdpbMf375X01mqWUH7tChyCpRr2hCLBQVCa6aJNmUODYaGME4axW1cEQRjXDOrDbOk5Aw0hqKmE3Rz6Lve1IOPeKuglnId3EqFvfTKydc7rZvLZ7-VpeCcMREbsEMDHXzXBWNPWQxyEC0X8iBaDqIlEBnFxdjVy3NPoX9mI8APwM7U3nY6-tLmhAFAIQohmIgjYJXr_8qv_KbtY_T6_dH_BkzUvHUmyGOicSH-hWy8e_spfwAwwrJ0</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection</title><source>MEDLINE</source><source>Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>Access via ScienceDirect (Elsevier)</source><creator>Caro-Codón, Juan ; Rey, Juan R. ; Buño, Antonio ; Iniesta, Angel M. ; Rosillo, Sandra O. ; Castrejon-Castrejon, Sergio ; Merino, Carlos ; Marco, Irene ; Martinez, Luis A. ; Garcia-Veas, Jose M. ; Martin-Polo, Lorena ; Rodriguez-Sotelo, Laura ; Martinez-Cossiani, Marcel ; Gonzalez-Valle, Luis ; Herrero, Alicia ; López-de-Sá, Esteban ; Merino, Jose L.</creator><creatorcontrib>Caro-Codón, Juan ; Rey, Juan R. ; Buño, Antonio ; Iniesta, Angel M. ; Rosillo, Sandra O. ; Castrejon-Castrejon, Sergio ; Merino, Carlos ; Marco, Irene ; Martinez, Luis A. ; Garcia-Veas, Jose M. ; Martin-Polo, Lorena ; Rodriguez-Sotelo, Laura ; Martinez-Cossiani, Marcel ; Gonzalez-Valle, Luis ; Herrero, Alicia ; López-de-Sá, Esteban ; Merino, Jose L. ; on behalf of the CARD-COVID Investigators ; CARD-COVID Investigators</creatorcontrib><description>Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19.
Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied.
A total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49–63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7–18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57–4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates.
Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.
El daño miocárdico parece una complicación frecuente en pacientes con COVID-19. Sin embargo, la literatura al respecto presenta serias limitaciones, como definiciones incorrectas, heterogeneidad de las determinaciones de troponina o seguimientos cortos. Utilizando datos de una cohorte amplia, el objetivo del trabajo fue caracterizar adecuadamente el daño miocárdico en pacientes con COVID-19 utilizando una metodología adecuada.
Se estudió a pacientes consecutivos con infección confirmada y determinaciones disponibles de troponina I de alta sensibilidad (hs-TnI), desde el 1 de marzo hasta el 20 de abril del 2020, que hubieran completado al menos un mes de seguimiento o fallecieran durante el periodo de estudio.
Se incluyó a 918 pacientes (edad 63,2±15,5 años, 60,1% varones) con un seguimiento mediano de 57 (49-63) días. De estos, 190 (20,7%) cumplían criterios estrictos de lesión miocárdica (21,1% crónica, 76,8% aguda no isquémica, 2,1% aguda isquémica). El tiempo desde el inicio de los síntomas hasta la hs-TnI máxima fue de 11 (7-18) días. Los eventos trombóticos y hemorrágicos, las arritmias, la insuficiencia cardíaca, la necesidad de ventilación mecánica y la muerte fueron significativamente más frecuentes en pacientes con concentraciones elevadas de hs-TnI, incluso por debajo del nivel de lesión miocárdica. La hs-TnI resultó un predictor independiente de mortalidad (HR 2,52 [(1,57-4,04] por cada 5 unidades logarítmicas).
La hs-TnI elevada es altamente prevalente entre los pacientes con COVID-19. Elevaciones leves muy por debajo del límite para definir lesión miocárdica se asociaron con más complicaciones y mayor mortalidad. La determinación protocolizada de hs-TnI en estos enfermos podría mejorar su estratificación pronóstica y los resultados clínicos.</description><identifier>ISSN: 0025-7753</identifier><identifier>EISSN: 1578-8989</identifier><identifier>DOI: 10.1016/j.medcli.2021.02.001</identifier><identifier>PMID: 33846001</identifier><language>eng</language><publisher>BARCELONA: Elsevier España, S.L.U</publisher><subject>Aged ; Biomarkers ; COVID-19 ; Daño miocárdico ; Female ; General & Internal Medicine ; Heart Failure ; Humans ; Life Sciences & Biomedicine ; Male ; Medicine, General & Internal ; Middle Aged ; Mortalidad ; Mortality ; Myocardial damage ; Original ; Outcomes ; Prognosis ; Pronóstico ; Resultados ; SARS-CoV-2 ; Science & Technology ; Troponin ; Troponin I ; Troponina</subject><ispartof>Medicina clinica, 2021-09, Vol.157 (6), p.274-280</ispartof><rights>2021 Elsevier España, S.L.U.</rights><rights>Copyright © 2021 Elsevier España, S.L.U. All rights reserved.</rights><rights>2021 Elsevier España, S.L.U. All rights reserved. 2021 Elsevier España, S.L.U.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>10</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000696994900004</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c463t-6653038c3d2f193023b4c2ce750d10d2482da8f2ce92111b4fce4f27840c106b3</citedby><cites>FETCH-LOGICAL-c463t-6653038c3d2f193023b4c2ce750d10d2482da8f2ce92111b4fce4f27840c106b3</cites><orcidid>0000-0001-7870-9413 ; 0000-0002-0466-7633 ; 0000-0002-4749-7451 ; 0000-0002-3504-6901 ; 0000-0002-8925-8766 ; 0000-0002-1737-1903</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.medcli.2021.02.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,781,785,886,3551,27929,27930,39263,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33846001$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Caro-Codón, Juan</creatorcontrib><creatorcontrib>Rey, Juan R.</creatorcontrib><creatorcontrib>Buño, Antonio</creatorcontrib><creatorcontrib>Iniesta, Angel M.</creatorcontrib><creatorcontrib>Rosillo, Sandra O.</creatorcontrib><creatorcontrib>Castrejon-Castrejon, Sergio</creatorcontrib><creatorcontrib>Merino, Carlos</creatorcontrib><creatorcontrib>Marco, Irene</creatorcontrib><creatorcontrib>Martinez, Luis A.</creatorcontrib><creatorcontrib>Garcia-Veas, Jose M.</creatorcontrib><creatorcontrib>Martin-Polo, Lorena</creatorcontrib><creatorcontrib>Rodriguez-Sotelo, Laura</creatorcontrib><creatorcontrib>Martinez-Cossiani, Marcel</creatorcontrib><creatorcontrib>Gonzalez-Valle, Luis</creatorcontrib><creatorcontrib>Herrero, Alicia</creatorcontrib><creatorcontrib>López-de-Sá, Esteban</creatorcontrib><creatorcontrib>Merino, Jose L.</creatorcontrib><creatorcontrib>on behalf of the CARD-COVID Investigators</creatorcontrib><creatorcontrib>CARD-COVID Investigators</creatorcontrib><title>Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection</title><title>Medicina clinica</title><addtitle>MED CLIN-BARCELONA</addtitle><addtitle>Med Clin (Barc)</addtitle><description>Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19.
Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied.
A total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49–63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7–18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57–4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates.
Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.
El daño miocárdico parece una complicación frecuente en pacientes con COVID-19. Sin embargo, la literatura al respecto presenta serias limitaciones, como definiciones incorrectas, heterogeneidad de las determinaciones de troponina o seguimientos cortos. Utilizando datos de una cohorte amplia, el objetivo del trabajo fue caracterizar adecuadamente el daño miocárdico en pacientes con COVID-19 utilizando una metodología adecuada.
Se estudió a pacientes consecutivos con infección confirmada y determinaciones disponibles de troponina I de alta sensibilidad (hs-TnI), desde el 1 de marzo hasta el 20 de abril del 2020, que hubieran completado al menos un mes de seguimiento o fallecieran durante el periodo de estudio.
Se incluyó a 918 pacientes (edad 63,2±15,5 años, 60,1% varones) con un seguimiento mediano de 57 (49-63) días. De estos, 190 (20,7%) cumplían criterios estrictos de lesión miocárdica (21,1% crónica, 76,8% aguda no isquémica, 2,1% aguda isquémica). El tiempo desde el inicio de los síntomas hasta la hs-TnI máxima fue de 11 (7-18) días. Los eventos trombóticos y hemorrágicos, las arritmias, la insuficiencia cardíaca, la necesidad de ventilación mecánica y la muerte fueron significativamente más frecuentes en pacientes con concentraciones elevadas de hs-TnI, incluso por debajo del nivel de lesión miocárdica. La hs-TnI resultó un predictor independiente de mortalidad (HR 2,52 [(1,57-4,04] por cada 5 unidades logarítmicas).
La hs-TnI elevada es altamente prevalente entre los pacientes con COVID-19. Elevaciones leves muy por debajo del límite para definir lesión miocárdica se asociaron con más complicaciones y mayor mortalidad. La determinación protocolizada de hs-TnI en estos enfermos podría mejorar su estratificación pronóstica y los resultados clínicos.</description><subject>Aged</subject><subject>Biomarkers</subject><subject>COVID-19</subject><subject>Daño miocárdico</subject><subject>Female</subject><subject>General & Internal Medicine</subject><subject>Heart Failure</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Medicine, General & Internal</subject><subject>Middle Aged</subject><subject>Mortalidad</subject><subject>Mortality</subject><subject>Myocardial damage</subject><subject>Original</subject><subject>Outcomes</subject><subject>Prognosis</subject><subject>Pronóstico</subject><subject>Resultados</subject><subject>SARS-CoV-2</subject><subject>Science & Technology</subject><subject>Troponin</subject><subject>Troponin I</subject><subject>Troponina</subject><issn>0025-7753</issn><issn>1578-8989</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkV1r2zAUhsVoWdKs_2AU3xd7Rx-2pZtCMN06CAzWdr0Usiw1CokVZCch-_WTlyxrb0qvjj6e90h6hNBnDBkGXHxZZCvT6KXLCBCcAckA8Ac0xnnJUy64OENjAJKnZZnTEbrousUwpbj8iEaUclZEfoyeqrkKSvcmuN-qd75NvE1We69VaJxaJq5dbMI-lkQl2s996AdgHVHT9l2yc_08uZ_-vE8r_yslkbNGD20-oXOrlp25PNYJevx6-1DdpbMf375X01mqWUH7tChyCpRr2hCLBQVCa6aJNmUODYaGME4axW1cEQRjXDOrDbOk5Aw0hqKmE3Rz6Lve1IOPeKuglnId3EqFvfTKydc7rZvLZ7-VpeCcMREbsEMDHXzXBWNPWQxyEC0X8iBaDqIlEBnFxdjVy3NPoX9mI8APwM7U3nY6-tLmhAFAIQohmIgjYJXr_8qv_KbtY_T6_dH_BkzUvHUmyGOicSH-hWy8e_spfwAwwrJ0</recordid><startdate>20210924</startdate><enddate>20210924</enddate><creator>Caro-Codón, Juan</creator><creator>Rey, Juan R.</creator><creator>Buño, Antonio</creator><creator>Iniesta, Angel M.</creator><creator>Rosillo, Sandra O.</creator><creator>Castrejon-Castrejon, Sergio</creator><creator>Merino, Carlos</creator><creator>Marco, Irene</creator><creator>Martinez, Luis A.</creator><creator>Garcia-Veas, Jose M.</creator><creator>Martin-Polo, Lorena</creator><creator>Rodriguez-Sotelo, Laura</creator><creator>Martinez-Cossiani, Marcel</creator><creator>Gonzalez-Valle, Luis</creator><creator>Herrero, Alicia</creator><creator>López-de-Sá, Esteban</creator><creator>Merino, Jose L.</creator><general>Elsevier España, S.L.U</general><general>Elsevier</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7870-9413</orcidid><orcidid>https://orcid.org/0000-0002-0466-7633</orcidid><orcidid>https://orcid.org/0000-0002-4749-7451</orcidid><orcidid>https://orcid.org/0000-0002-3504-6901</orcidid><orcidid>https://orcid.org/0000-0002-8925-8766</orcidid><orcidid>https://orcid.org/0000-0002-1737-1903</orcidid></search><sort><creationdate>20210924</creationdate><title>Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection</title><author>Caro-Codón, Juan ; Rey, Juan R. ; Buño, Antonio ; Iniesta, Angel M. ; Rosillo, Sandra O. ; Castrejon-Castrejon, Sergio ; Merino, Carlos ; Marco, Irene ; Martinez, Luis A. ; Garcia-Veas, Jose M. ; Martin-Polo, Lorena ; Rodriguez-Sotelo, Laura ; Martinez-Cossiani, Marcel ; Gonzalez-Valle, Luis ; Herrero, Alicia ; López-de-Sá, Esteban ; Merino, Jose L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-6653038c3d2f193023b4c2ce750d10d2482da8f2ce92111b4fce4f27840c106b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Biomarkers</topic><topic>COVID-19</topic><topic>Daño miocárdico</topic><topic>Female</topic><topic>General & Internal Medicine</topic><topic>Heart Failure</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Male</topic><topic>Medicine, General & Internal</topic><topic>Middle Aged</topic><topic>Mortalidad</topic><topic>Mortality</topic><topic>Myocardial damage</topic><topic>Original</topic><topic>Outcomes</topic><topic>Prognosis</topic><topic>Pronóstico</topic><topic>Resultados</topic><topic>SARS-CoV-2</topic><topic>Science & Technology</topic><topic>Troponin</topic><topic>Troponin I</topic><topic>Troponina</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Caro-Codón, Juan</creatorcontrib><creatorcontrib>Rey, Juan R.</creatorcontrib><creatorcontrib>Buño, Antonio</creatorcontrib><creatorcontrib>Iniesta, Angel M.</creatorcontrib><creatorcontrib>Rosillo, Sandra O.</creatorcontrib><creatorcontrib>Castrejon-Castrejon, Sergio</creatorcontrib><creatorcontrib>Merino, Carlos</creatorcontrib><creatorcontrib>Marco, Irene</creatorcontrib><creatorcontrib>Martinez, Luis A.</creatorcontrib><creatorcontrib>Garcia-Veas, Jose M.</creatorcontrib><creatorcontrib>Martin-Polo, Lorena</creatorcontrib><creatorcontrib>Rodriguez-Sotelo, Laura</creatorcontrib><creatorcontrib>Martinez-Cossiani, Marcel</creatorcontrib><creatorcontrib>Gonzalez-Valle, Luis</creatorcontrib><creatorcontrib>Herrero, Alicia</creatorcontrib><creatorcontrib>López-de-Sá, Esteban</creatorcontrib><creatorcontrib>Merino, Jose L.</creatorcontrib><creatorcontrib>on behalf of the CARD-COVID Investigators</creatorcontrib><creatorcontrib>CARD-COVID Investigators</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medicina clinica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Caro-Codón, Juan</au><au>Rey, Juan R.</au><au>Buño, Antonio</au><au>Iniesta, Angel M.</au><au>Rosillo, Sandra O.</au><au>Castrejon-Castrejon, Sergio</au><au>Merino, Carlos</au><au>Marco, Irene</au><au>Martinez, Luis A.</au><au>Garcia-Veas, Jose M.</au><au>Martin-Polo, Lorena</au><au>Rodriguez-Sotelo, Laura</au><au>Martinez-Cossiani, Marcel</au><au>Gonzalez-Valle, Luis</au><au>Herrero, Alicia</au><au>López-de-Sá, Esteban</au><au>Merino, Jose L.</au><aucorp>on behalf of the CARD-COVID Investigators</aucorp><aucorp>CARD-COVID Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection</atitle><jtitle>Medicina clinica</jtitle><stitle>MED CLIN-BARCELONA</stitle><addtitle>Med Clin (Barc)</addtitle><date>2021-09-24</date><risdate>2021</risdate><volume>157</volume><issue>6</issue><spage>274</spage><epage>280</epage><pages>274-280</pages><issn>0025-7753</issn><eissn>1578-8989</eissn><abstract>Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19.
Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied.
A total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49–63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7–18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57–4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates.
Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.
El daño miocárdico parece una complicación frecuente en pacientes con COVID-19. Sin embargo, la literatura al respecto presenta serias limitaciones, como definiciones incorrectas, heterogeneidad de las determinaciones de troponina o seguimientos cortos. Utilizando datos de una cohorte amplia, el objetivo del trabajo fue caracterizar adecuadamente el daño miocárdico en pacientes con COVID-19 utilizando una metodología adecuada.
Se estudió a pacientes consecutivos con infección confirmada y determinaciones disponibles de troponina I de alta sensibilidad (hs-TnI), desde el 1 de marzo hasta el 20 de abril del 2020, que hubieran completado al menos un mes de seguimiento o fallecieran durante el periodo de estudio.
Se incluyó a 918 pacientes (edad 63,2±15,5 años, 60,1% varones) con un seguimiento mediano de 57 (49-63) días. De estos, 190 (20,7%) cumplían criterios estrictos de lesión miocárdica (21,1% crónica, 76,8% aguda no isquémica, 2,1% aguda isquémica). El tiempo desde el inicio de los síntomas hasta la hs-TnI máxima fue de 11 (7-18) días. Los eventos trombóticos y hemorrágicos, las arritmias, la insuficiencia cardíaca, la necesidad de ventilación mecánica y la muerte fueron significativamente más frecuentes en pacientes con concentraciones elevadas de hs-TnI, incluso por debajo del nivel de lesión miocárdica. La hs-TnI resultó un predictor independiente de mortalidad (HR 2,52 [(1,57-4,04] por cada 5 unidades logarítmicas).
La hs-TnI elevada es altamente prevalente entre los pacientes con COVID-19. Elevaciones leves muy por debajo del límite para definir lesión miocárdica se asociaron con más complicaciones y mayor mortalidad. La determinación protocolizada de hs-TnI en estos enfermos podría mejorar su estratificación pronóstica y los resultados clínicos.</abstract><cop>BARCELONA</cop><pub>Elsevier España, S.L.U</pub><pmid>33846001</pmid><doi>10.1016/j.medcli.2021.02.001</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7870-9413</orcidid><orcidid>https://orcid.org/0000-0002-0466-7633</orcidid><orcidid>https://orcid.org/0000-0002-4749-7451</orcidid><orcidid>https://orcid.org/0000-0002-3504-6901</orcidid><orcidid>https://orcid.org/0000-0002-8925-8766</orcidid><orcidid>https://orcid.org/0000-0002-1737-1903</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0025-7753 |
| ispartof | Medicina clinica, 2021-09, Vol.157 (6), p.274-280 |
| issn | 0025-7753 1578-8989 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7988449 |
| source | MEDLINE; Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Access via ScienceDirect (Elsevier) |
| subjects | Aged Biomarkers COVID-19 Daño miocárdico Female General & Internal Medicine Heart Failure Humans Life Sciences & Biomedicine Male Medicine, General & Internal Middle Aged Mortalidad Mortality Myocardial damage Original Outcomes Prognosis Pronóstico Resultados SARS-CoV-2 Science & Technology Troponin Troponin I Troponina |
| title | Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-11T22%3A37%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-pubmed_elsev&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Characterization%20of%20myocardial%20injury%20in%20a%20cohort%20of%20patients%20with%20SARS-CoV-2%20infection&rft.jtitle=Medicina%20clinica&rft.au=Caro-Cod%C3%B3n,%20Juan&rft.aucorp=on%20behalf%20of%20the%20CARD-COVID%20Investigators&rft.date=2021-09-24&rft.volume=157&rft.issue=6&rft.spage=274&rft.epage=280&rft.pages=274-280&rft.issn=0025-7753&rft.eissn=1578-8989&rft_id=info:doi/10.1016/j.medcli.2021.02.001&rft_dat=%3Cpubmed_elsev%3E33846001%3C/pubmed_elsev%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/33846001&rft_els_id=S0025775321000920&rfr_iscdi=true |