Abstract
Background: The COVID-19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or non-specific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities, and mortality.Methods: We retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID-19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion.Results: Mortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was >1 ng/ml. In patients with mild Troponin rise (0.05–1.00 ng/ml) the presence of ECG abnormality and particularly T wave inversions resulted in significantly greater mortality.Conclusion: ECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID-19.
Highlights
Coronavirus Disease (COVID19) pandemic, induced by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is reaching historical magnitude as one of the deadliest outbreaks in modern history [1]
Data reviewed from each ECG included heart rate, rhythm categorized as normal sinus rhythm or atrial fibrillation/flutter (AF), atrioventricular block (AVB), right bundle branch block (RBBB), left bundle branch block (LBBB), a non-specific intraventricular conduction block (QRS duration >120 ms), the presence of ST segment or T-wave changes
Abnormal intraventricular conduction was found in 11%
Summary
Coronavirus Disease (COVID19) pandemic, induced by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is reaching historical magnitude as one of the deadliest outbreaks in modern history [1]. Recent reports [3, 4] revealed that cardiac complications are common (≈20–25%) in COVID19 infection and are associated with increased mortality. In those reports, “cardiac complications” were defined according to clinical and laboratory parameters (troponin levels) without systematic electrocardiographic (ECG) evaluation. It is unknown if elevations in troponin levels are reflective of a primary myocardial infarction, supply-demand inequity, or non-ischemic direct myocardial injury. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or non-specific supply-demand imbalance. We assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities, and mortality
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