Abstract 15808: Relationship Between Myocardial Injury, Wall Motion Abnormalities and Mortality in Patients With Covid-19: The Circ-19 Registry

Abstract

Introduction: Myocardial injury is commonly observed in patients (pts) with Coronarvirus disease 2019 (Covid-19) but its anatomical correlate has not been elucidated. We evaluated the association between presence of transthoracic echocardiographic (TTE) left ventricular (LV) regional wall motion abnormalities (RWMA), myocardial injury and outcomes in Covid-19 pts. Methods: We conducted a cohort study including 7 hospitals in New York City (US) and Milan (Italy) of hospitalized pts with confirmed Covid-19 who had a TTE during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin (cTn) during the hospitalization. Using multivariable logistic regression, we analyzed the association between RWMA, myocardial injury and in-hospital death. Results: Among 305 total pts included in the study, 49 (16%) had RWMA and 44 (14%) had global LV systolic dysfunction. Among those with RWMA, 31/49 (63%) had LV ejection fraction <50%. Compared to pts without RWMA, pts with RWMA more commonly had chest pain at time of presentation (36% vs. 14%; p=0.001), ST segment changes on ECG (33% vs. 6%; p<0.0001) and myocardial injury (90% vs. 57%; p<0.001). After multivariable analysis, RWMA remained associated with myocardial injury (adjOR: 5.92; 95% CI: 2.17-16.17), but not death. Left heart catheterization (LHC) was performed in 9 of the 49 (18%) pts with RWMA, 8 of which had confirmed ACS and 7 underwent PCI. Myocardial injury was associated with higher risk of death regardless of the presence or absence of RWMA ( Figure 1 ). Conclusion: In Covid-19 pts, RWMA are associated with typical ACS presentation: chest pain, ST changes and cTn elevations. Accordingly, a large proportion of pts with RWMA who underwent LHC had confirmed ACS warranting PCI. Though myocardial injury was associated with increased risk of in-hospital death regardless of the presence of RWMA, LHC should be considered for pts with RWMA and myocardial injury to rule-out obstructive disease.