Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Feb 9;143(6):553-565.
doi: 10.1161/CIRCULATIONAHA.120.050543. Epub 2020 Nov 13.

Myocardial Injury in Severe COVID-19 Compared With Non-COVID-19 Acute Respiratory Distress Syndrome

Thomas S Metkus  1 , Lori J Sokoll  2 , Andreas S Barth  1 , Matthew J Czarny  1 , Allison G Hays  1 , Charles J Lowenstein  1 , Erin D Michos  1 , Eric P Nolley  3 , Wendy S Post  1 , Jon R Resar  1 , David R Thiemann  1 , Jeffrey C Trost  1 , Rani K Hasan  1
Affiliations
Comparative Study

Myocardial Injury in Severe COVID-19 Compared With Non-COVID-19 Acute Respiratory Distress Syndrome

Thomas S Metkus et al. Circulation. .

Abstract

Background: Knowledge gaps remain in the epidemiology and clinical implications of myocardial injury in coronavirus disease 2019 (COVID-19). We aimed to determine the prevalence and outcomes of myocardial injury in severe COVID-19 compared with acute respiratory distress syndrome (ARDS) unrelated to COVID-19.

Methods: We included intubated patients with COVID-19 from 5 hospitals between March 15 and June 11, 2020, with troponin levels assessed. We compared them with patients from a cohort study of myocardial injury in ARDS and performed survival analysis with primary outcome of in-hospital death associated with myocardial injury. In addition, we performed linear regression to identify clinical factors associated with myocardial injury in COVID-19.

Results: Of 243 intubated patients with COVID-19, 51% had troponin levels above the upper limit of normal. Chronic kidney disease, lactate, ferritin, and fibrinogen were associated with myocardial injury. Mortality was 22.7% among patients with COVID-19 with troponin under the upper limit of normal and 61.5% for those with troponin levels >10 times the upper limit of normal (P<0.001). The association of myocardial injury with mortality was not statistically significant after adjusting for age, sex, and multisystem organ dysfunction. Compared with patients with ARDS without COVID-19, patients with COVID-19 were older and had higher creatinine levels and less favorable vital signs. After adjustment, COVID-19-related ARDS was associated with lower odds of myocardial injury compared with non-COVID-19-related ARDS (odds ratio, 0.55 [95% CI, 0.36-0.84]; P=0.005).

Conclusions: Myocardial injury in severe COVID-19 is a function of baseline comorbidities, advanced age, and multisystem organ dysfunction, similar to traditional ARDS. The adverse prognosis of myocardial injury in COVID-19 relates largely to multisystem organ involvement and critical illness.

Trial registration: ClinicalTrials.gov NCT04435184.

Keywords: COVID-19; respiratory distress syndrome; troponin.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Mortality within each category of troponin level and distribution of troponin stratified by survival status. A, Mortality within each category of troponin level (P<0.001 for difference in proportions and for trend). B, Distribution of troponin stratified by survival status (P<0.001 for difference in proportions). COVID-19 indicates coronavirus disease 2019; and ULN, upper limit of normal.
Figure 2.
Figure 2.
Kaplan-Meier survival curves for intubated patients with COVID-19. Kaplan-Meier survival curves for intubated patients with COVID-19 by presence of any myocardial injury (A) and by category of troponin level (B). COVID-19 indicates coronavirus disease 2019; and ULN, upper limit of normal.
Figure 3.
Figure 3.
Univariable and adjusted hazard ratios for intubated patients with COVID-19 by presence of any myocardial injury and by category of troponin level. Cox proportional hazard models adjusted first for age and sex and then for age, sex, creatinine, bilirubin, Pao2/FIo2 ratio, vasopressor use, and lactate levels. COVID-19 indicates coronavirus disease 2019; and ULN, upper limit of normal.
Figure 4.
Figure 4.
Kaplan-Meier survival curves for COVID-19 versus ARDS pneumonia and presence or absence of myocardial injury. ARDS indicates acute respiratory distress syndrome; and COVID-19, coronavirus disease 2019.
See this image and copyright information in PMC

References

    1. Santoso A, Pranata R, Wibowo A, Al-Farabi MJ, Huang I, Antariksa B. Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: a meta-analysis [published online April 19, 2020]. Am J Emerg Med. doi: 10.1016/j.ajem.2020.04.052. https://www.ajemjournal.com/article/S0735-6757(20)30280-1/fulltext - PMC - PubMed
    1. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang X, Lu Z. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020;5:811–818. doi: 10.1001/jamacardio.2020.1017 - PMC - PubMed
    1. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W, Liu X, Liang J, Zhao Q, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5:802–810. doi: 10.1001/jamacardio.2020.0950 - PMC - PubMed
    1. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, Guo GY, Du J, Zheng CL, Zhu Q, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55:2000524 doi: 10.1183/13993003.00524-2020. - PMC - PubMed
    1. Hu L, Chen S, Fu Y, Gao Z, Long H, Wang JM, Ren HW, Zuo Y, Li H, Wang J, et al. Risk factors associated with clinical outcomes in 323 COVID-19 hospitalized patients in Wuhan, China. Clin Infect Dis. 2020;71:2089–2098. doi: 10.1093/cid/ciaa539 - PMC - PubMed

Publication types

MeSH terms

Associated data