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Observational Study
. 2021 Aug 5;67(8):1080-1089.
doi: 10.1093/clinchem/hvab062.

High-Sensitivity Cardiac Troponin T for the Detection of Myocardial Injury and Risk Stratification in COVID-19

Laura De Michieli  1   2 , Olatunde Ola  3   4 , Jonathan D Knott  5 , Ashok Akula  3 , Ramila A Mehta  6 , David O Hodge  7 , Marshall Dworak  8 , Eric H Yang  9 , Michael Gharacholou  10 , Gurpreet Singh  11 , Ripudamanjit Singh  12 , Rajiv Gulati  1 , Allan S Jaffe  1   13 , Yader Sandoval  1
Affiliations
Observational Study

High-Sensitivity Cardiac Troponin T for the Detection of Myocardial Injury and Risk Stratification in COVID-19

Laura De Michieli et al. Clin Chem. .

Abstract

Background: Limited data exist on high-sensitivity cardiac troponin (hs-cTn) for risk-stratification in COVID-19.

Methods: We conducted a multicenter, retrospective, observational, US-based study of COVID-19 patients undergoing hs-cTnT. Outcomes included short-term mortality (in-hospital and 30-days post-discharge) and a composite of major adverse events, including respiratory failure requiring mechanical ventilation, cardiac arrest, and shock within the index presentation and/or mortality during the index hospitalization or within 30-days post-discharge.

Results: Among 367 COVID-19 patients undergoing hs-cTnT, myocardial injury was identified in 46%. They had a higher risk for mortality (20% vs 12%, P < 0.0001; unadjusted HR 4.44, 95% CI 2.13-9.25, P < 0.001) and major adverse events (35% vs. 11%, P < 0.0001; unadjusted OR 4.29, 95% CI 2.50-7.40, P < 0.0001). Myocardial injury was associated with major adverse events (adjusted OR 3.84, 95% CI 2.00-7.36, P < 0.0001) but not mortality. Baseline (adjusted OR 1.003, 95% CI 1.00-1.007, P = 0.047) and maximum (adjusted OR 1.005, 95% CI 1.001-1.009, P = 0.0012) hs-cTnT were independent predictors of major adverse events. Most (95%) increases were due to myocardial injury, with 5% (n = 8) classified as type 1 or 2 myocardial infarction. A single hs-cTnT <6 ng/L identified 26% of patients without mortality, with a 94.9% (95% CI 87.5-98.6) negative predictive value and 93.1% sensitivity (95% CI 83.3-98.1) for major adverse events in those presenting to the ED.

Conclusions: Myocardial injury is frequent and prognostic in COVID-19. While most hs-cTnT increases are modest and due to myocardial injury, they have important prognostic implications. A single hs-cTnT <6 ng/L at presentation may facilitate the identification of patients with a favorable prognosis.

Keywords: COVID-19; high sensitivity cardiac troponin T; myocardial infarction; myocardial injury; risk stratification.

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Figures

Fig. 1.
Fig. 1.
Histogram for the distribution of baseline (panel A) and maximum (panel B) hs-cTnT concentrations.
Fig. 2.
Fig. 2.
Survival among COVID-19 patients with and without myocardial injury.
Fig. 3.
Fig. 3.
Survival among COVID-19 patients according to baseline (A) and maximum (B) hs-cTnT concentrations based on analytical ranges: below the LoQ, LoQ to 99th percentile, and above sex-specific 99th percentiles.
See this image and copyright information in PMC

Comment in

  • Mechanisms of Myocardial Injury in COVID-19.
    Bularga A, Chapman AR, Mills NL. Bularga A, et al. Clin Chem. 2021 Aug 5;67(8):1044-1046. doi: 10.1093/clinchem/hvab111. Clin Chem. 2021. PMID: 34117871 Free PMC article. No abstract available.

References

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