Abstract 17183: Severity of Myocardial Injury in COVID-19 Hospitalized Patients

Abstract

Introduction: Myocardial injury in COVID19 is reported as high as 30% and associated with worsened prognosis (Cooper et al., Circulation). Along with elevated cardiac biomarkers, elevated inflammatory markers of cytokine storm and hemophagocytic lymphohistiocytosis (HLH) are associated with increased illness severity and mortality. Our study aimed to identify patients at highest risk for myocardial injury and subsequent cardiac decompensation. Methods: 279 consecutive patients with COVID19 from a major metropolitan academic center, discharged from 3-21-2020 to 5-17-2020, were analyzed. Primary data includes age, sex, race, and peak troponin I during hospitalization. Patients were further stratified to evaluate severe cases with acute respiratory distress syndrome (ARDS) requiring intubation (n=40), and peak levels of CRP, ferritin, and D-dimer were collected. Bivariate and multivariate measures of association between peak inflammatory marker and troponin I levels were estimated. Results: Average age of ARDS population patients was 61 +/- 15 years; 50% male and 50% female. Self-identified African Americans(AA) were 35%, Hispanic/Latinos(H/L) were 55%, and Others including two White Americans were 10%. Average peak troponin I in H/L was remarkably higher 0.51 +/-1.16 compared to AA 0.18 +/- 0.23 and Others 0.13 +/- 0.16. Per multivariate regression analysis, D-dimer had the most significant effect on the elevated troponin (p=0.027). Although weakly significant, H/L showed elevated troponin (p =0.09) compared to non-H/L. Conclusion: Elevated D-dimer is associated with increased morbidity in COVID19, and also correlates with elevated troponin concerning for increased myocardial injury. Furthermore, the H/L population may be at greater risk for developing myocardial injury and have more injury as shown by higher troponin I levels. Larger studies may better assess the relation between inflammatory markers such as CRP and ferritin and myocardial injury. Our study provides evidence of systemic inflammation contributing to significant myocardial injury in COVID19, especially in the H/L population. Identifying patients at highest risk for myocardial injury early may allow for more effective medical interventions and improved outcomes.