Abstract
Background Since December 2019, an emerging outbreak of novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2). The aim of the present report is to describe a population with elevated levels of high-sensitive cardiac troponin T (hs-cTnT) and report on their management during the pandemic of COVID-19. Methods In this retrospective cohort, we collected data from all patients with hs-cTnT levels of >50 ng/mL admitted to Fribourg Hospital between February 15, 2020, and April 15, 2020. The primary diagnosis for troponin elevation was recorded. Echocardiographic, electrocardiographic, and coronary angiographic data were analyzed for signs of myocardial ischemia, infarction, or other cardiomyopathies. In-hospital follow-up was performed for deaths from all causes and for cardiac deaths. Propensity score matching was used in a subgroup analysis to match COVID-19 and non-COVID-19 patients ( n = 21 per group). Results Overall, 215 patients with high hs-cTnT levels were enrolled. The median age was 75 [65–83] years and 30% were women. 21 patients (10%) were diagnosed with COVID-19. Of these, acute myocardial injury related to COVID-19 was the most commonly described cardiovascular manifestation during the pandemic peak. Median troponin values were not different between COVID-19 patients and non-COVID-19 patients (94 vs. 137, p = 0.14). The number of cardiological examinations was globally low (echocardiography 51% and coronary angiography 52%) in the context of the pandemic. Patients in the COVID-19 group underwent significantly less echocardiographic examinations (19 vs. 55%, p ≤ 0.01) and coronary angiographies (5 vs. 58%, p ≤ 0.01) than non-COVID-19 patients. Overall mortality in patient with COVID-19 and elevated troponins was very high, as 38% of patients died during hospitalization including 14% for cardiac death. This trend was confirmed in the propensity score–matched analysis. Conclusion Interpretation of troponins during the COVID-19 pandemic was complicated due to the low number of cardiovascular investigations in this context. Follow-up of patients with COVID-19 and cardiovascular events is important to assess their prognosis and to improve their care.
Highlights
Since December 2019, a large global outbreak of the novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2).1 The pandemic has been spreading in Switzerland since February 2020.2 COVID-19 most commonly manifests with respiratory illness3 but cardiovascular involvement has been confirmed
The rates of prior hypertension, smoking, diabetes and dyslipidemia were 67, 20, 22, and 49% respectively. ►Table 1 shows the baseline characteristics of all patients
The main findings of this report are as follows: (1) among patients with elevated troponins during the pandemic peak, 10% were diagnosed with COVID-19; (2) cardiovascular manifestations in patients with COVID-19 infection was varied, ranging from myocardial injury, segment elevation myocardial infarction (STEMI), type-2 myocardial infarction (MI), and stress-induced cardiomyopathy; and (3) in-hospital mortality and cardiac mortality of COVID-19 patients with troponins were high
Summary
Since December 2019, a large global outbreak of the novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The pandemic has been spreading in Switzerland since February 2020.2 COVID-19 most commonly manifests with respiratory illness but cardiovascular involvement has been confirmed. The pandemic has been spreading in Switzerland since February 2020.2 COVID-19 most commonly manifests with respiratory illness but cardiovascular involvement has been confirmed. This is due to both the high prevalence of cardiovascular disease in COVID-19 patients and the development of de novo cardiac complications.. Overall mortality in patient with COVID-19 and elevated troponins was very high, as 38% of patients died during hospitalization including 14% for cardiac death. This trend was confirmed in the propensity score– matched analysis
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