Serial Assessment of Myocardial Injury Markers in Mechanically Ventilated Patients With SARS-CoV-2 (from the Prospective MaastrICCht Cohort)

Mohammed A Ghossein,Rob G.H Driessen,Frank Van Rosmalen,Jan-Willem E.M Sels,Thijs Delnoij,Zafer Geyik,Alma M.A Mingels,Antonius M.W Van Stipdonk,Frits W Prinzen,Chahinda Ghossein-Doha,Sander M.J Van Kuijk,Iwan C.C Van Der Horst,Kevin Vernooy,Bas C.T Van Bussel

doi:10.1016/j.amjcard.2022.01.030

Abstract

Myocardial injury in COVID-19 is associated with in-hospital mortality. However, the development of myocardial injury over time and whether myocardial injury in patients with COVID-19 at the intensive care unit is associated with outcome is unclear. This study prospectively investigates myocardial injury with serial measurements over the full course of intensive care unit admission in mechanically ventilated patients with COVID-19. As part of the prospective Maastricht Intensive Care COVID cohort, predefined myocardial injury markers, including high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and electrocardiographic characteristics were serially collected in mechanically ventilated patients with COVID-19. Linear mixed-effects regression was used to compare survivors with nonsurvivors, adjusting for gender, age, APACHE-II score, daily creatinine concentration, hypertension, diabetes mellitus, and obesity. In 90 patients, 57 (63%) were survivors and 33 (37%) nonsurvivors, and a total of 628 serial electrocardiograms, 1,565 hs-cTnT, and 1,559 NT-proBNP concentrations were assessed. Log-hs-cTnT was lower in survivors compared with nonsurvivors at day 1 (β −0.93 [−1.37; −0.49], p <0.001) and did not change over time. Log-NT-proBNP did not differ at day 1 between both groups but decreased over time in the survivor group (β −0.08 [−0.11; −0.04] p <0.001) compared with nonsurvivors. Many electrocardiographic abnormalities were present in the whole population, without significant differences between both groups. In conclusion, baseline hs-cTnT and change in NT-proBNP were strongly associated with mortality. Two-thirds of patients with COVID-19 showed electrocardiographic abnormalities. Our serial assessment suggests that myocardial injury is common in mechanically ventilated patients with COVID-19 and is associated with outcome.

Highlights

Our main findings are that (1) higher high-sensitivity cardiac troponin T (hscTnT) at day 1 was associated with mortality (p
Our findings underscore the importance of serial assessment of the cardiac biomarkers, especially NTproBNP, as opposed to single measurements
Hs-cTnT was associated with mortality on admission in the intensive care unit (ICU)

Summary

Introduction

SARS-CoV-2 resulting in COVID-19 is often complicated by multiorgan failure, including myocardial injury[1] and thrombosis.[2,3]. Myocardial injury, based on elevated cardiac troponin (cTn),[4] is reported in 4% to 37% of patients with COVID-19 and may be the consequence of viral myocarditis, type I myocardial infarction caused by atherosclerotic plaque disruption, or type II myocardial infarction caused by an imbalance between oxygen demand and supply.[5−7] N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of hemodynamic myocardial stress and heart failure, but it can be elevated in patients with severe inflammatory and respiratory disease.[8,9]. QTc intervals are associated with major adverse events, infection severity, and transfer to the intensive care unit (ICU).[10,11]. In this study, we investigated myocardial injury development by serial cardiac biomarkers and serial electrocardiograms from intubation onward over the disease course, comparing ICU survivors and nonsurvivors

Methods

Results

Conclusion