tetano
Editor, Senior Moderator
Intern Emerg Med
. 2020 Sep 28;1-10.
doi: 10.1007/s11739-020-02498-7. Online ahead of print.
Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients
Luca Arcari[SUP] 1 2 [/SUP], Michelangelo Luciani[SUP] 3 [/SUP], Luca Cacciotti[SUP] 4 5 [/SUP], Maria Beatrice Musumeci[SUP] 6 7 [/SUP], Valerio Spuntarelli[SUP] 3 8 [/SUP], Eleonora Pistella[SUP] 5 9 [/SUP], Dario Martolini[SUP] 5 9 [/SUP], Daniele Manzo[SUP] 4 5 [/SUP], Mariateresa Pucci[SUP] 5 [/SUP], Claudio Marone[SUP] 5 9 [/SUP], Serena Melandri[SUP] 5 9 [/SUP], Gerardo Ansalone[SUP] 4 [/SUP], Claudio Santini[SUP] 5 9 [/SUP], Paolo Martelletti[SUP] 3 8 [/SUP], Massimo Volpe[SUP] 6 10 [/SUP], Luciano De Biase[SUP] 7 11 [/SUP]
Affiliations
Abstract
Background: Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia.
Methods: In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range.
Results: Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B = - 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively).
Conclusions: Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.
Keywords: COVID-19; D-dimer; Hs-troponin; Natriuretic peptide; PaO2/FIO2.
. 2020 Sep 28;1-10.
doi: 10.1007/s11739-020-02498-7. Online ahead of print.
Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients
Luca Arcari[SUP] 1 2 [/SUP], Michelangelo Luciani[SUP] 3 [/SUP], Luca Cacciotti[SUP] 4 5 [/SUP], Maria Beatrice Musumeci[SUP] 6 7 [/SUP], Valerio Spuntarelli[SUP] 3 8 [/SUP], Eleonora Pistella[SUP] 5 9 [/SUP], Dario Martolini[SUP] 5 9 [/SUP], Daniele Manzo[SUP] 4 5 [/SUP], Mariateresa Pucci[SUP] 5 [/SUP], Claudio Marone[SUP] 5 9 [/SUP], Serena Melandri[SUP] 5 9 [/SUP], Gerardo Ansalone[SUP] 4 [/SUP], Claudio Santini[SUP] 5 9 [/SUP], Paolo Martelletti[SUP] 3 8 [/SUP], Massimo Volpe[SUP] 6 10 [/SUP], Luciano De Biase[SUP] 7 11 [/SUP]
Affiliations
- PMID: 32986136
- PMCID: PMC7520380
- DOI: 10.1007/s11739-020-02498-7
Abstract
Background: Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia.
Methods: In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range.
Results: Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B = - 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively).
Conclusions: Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.
Keywords: COVID-19; D-dimer; Hs-troponin; Natriuretic peptide; PaO2/FIO2.