Underlying cardiovascular disease was not necessarily linked with fatal outcomes in patients with COVID-19, while myocardial injury was, a new study suggests.
“Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents,” the authors wrote. “Information regarding the impact of cardiovascular complication on fatal outcome is scarce.”
Important to risk stratify #COVID19 pts with serial ❤️ biomarkers & understand their CV Hx & risk factors, ++ correlation with prognosis. Potential earlier immunomodulatory therapy in the hyperinflammatory state for CV pts? @gcfmd @gcfmd @MRMehraMD @NidaQadirMD @drtishawang https://t.co/2Wys9PyvFM
— Ali Nsair, MD (@AliNsairMD) March 27, 2020
Researchers from a single center in Wuhan, China, the original epicenter of the COVID-19 outbreak, looked at 187 patients with laboratory-confirmed COVID-19 infections (144 of whom were discharged and 43 who died during the course of the study).
The authors reported that 66 of the patients in the overall sample had underlying cardiovascular disease (including hypertension, coronary heart disease, and cardiomyopathy). There were also 52 patients who had myocardial injury as indicated by troponin-T levels. The researchers reported a 7.62% mortality rate during hospitalization for patients without underlying cardiovascular disease and normal troponin-T levels; 13.33% in patients with underlying CVD but normal troponin-T levels; and 69.44% in those with underlying CVD and elevated troponin-T levels. Plasma troponin-T levels demonstrated a significant linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530, P< 0.01) and N-terminal pro–brain natriuretic peptide (NT-proBNP) levels (β = 0.613, P<0.01).
Plasma troponin-T and NT-proBNP levels during hospitalization and impending death were increased significantly compared with admission values in patients who did not survive. There were while no significant dynamic changes of troponin-T levels, and NT-proBNP was observed in survivors.
“Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying cardiovascular disease but without myocardial injury is relatively favorable” the researchers wrote. “Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.”
The study was published in JAMA Cardiology.
Chinese data supports anecdotal reports of myocardial damage in #covid-19. Dramatically elevated mortality among those with elevated troponin WITHOUT history of CVD: https://t.co/szGz1ehwpj pic.twitter.com/E8C96ISt5y
— F. Perry Wilson, MD MSCE (@methodsmanmd) March 27, 2020
Much more on the heart and #COVID19 today@JAMACardio https://t.co/1ORaDrEx9c "the wake up call has been delivered"https://t.co/C1BrAEncKG case report without pneumoniahttps://t.co/soXEMg4W4P association with fatality pic.twitter.com/DeCaT2XSbx
— Eric Topol (@EricTopol) March 27, 2020
Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) https://t.co/JjVBucmujl. @JAMACardio @NMHheartdoc @Drroxmehran @ajaykirtane @texhern @HFSA @AliNsairMD @JeffHsuMD pic.twitter.com/D7xK3q2RYj
— Gregg Fonarow MD (@gcfmd) March 27, 2020