TY - JOUR
T1 - Characterization of Myocardial Injury in Patients With COVID-19
AU - Giustino, Gennaro
AU - Croft, Lori B.
AU - Stefanini, Giulio G.
AU - Bragato, Renato
AU - Silbiger, Jeffrey J.
AU - Vicenzi, Marco
AU - Danilov, Tatyana
AU - Kukar, Nina
AU - Shaban, Nada
AU - Kini, Annapoorna
AU - Camaj, Anton
AU - Bienstock, Solomon W.
AU - Rashed, Eman R.
AU - Rahman, Karishma
AU - Oates, Connor P.
AU - Buckley, Samantha
AU - Elbaum, Lindsay S.
AU - Arkonac, Derya
AU - Fiter, Ryan
AU - Singh, Ranbir
AU - Li, Emily
AU - Razuk, Victor
AU - Robinson, Sam E.
AU - Miller, Michael
AU - Bier, Benjamin
AU - Donghi, Valeria
AU - Pisaniello, Marco
AU - Mantovani, Riccardo
AU - Pinto, Giuseppe
AU - Rota, Irene
AU - Baggio, Sara
AU - Chiarito, Mauro
AU - Fazzari, Fabio
AU - Cusmano, Ignazio
AU - Curzi, Mirko
AU - Ro, Richard
AU - Malick, Waqas
AU - Kamran, Mazullah
AU - Kohli-Seth, Roopa
AU - Bassily-Marcus, Adel M.
AU - Neibart, Eric
AU - Serrao, Gregory
AU - Perk, Gila
AU - Mancini, Donna
AU - Reddy, Vivek Y.
AU - Pinney, Sean P.
AU - Dangas, George
AU - Blasi, Francesco
AU - Sharma, Samin K.
AU - Mehran, Roxana
AU - Condorelli, Gianluigi
AU - Stone, Gregg W.
AU - Fuster, Valentin
AU - Lerakis, Stamatios
AU - Goldman, Martin E.
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/11/3
Y1 - 2020/11/3
N2 - Background: Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. Objectives: This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. Methods: We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. Results: A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. Conclusions: Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.
AB - Background: Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. Objectives: This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. Methods: We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. Results: A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. Conclusions: Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.
KW - COVID-19
KW - echocardiography
KW - myocardial infarction
KW - myocardial injury
UR - http://www.scopus.com/inward/record.url?scp=85092915671&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2020.08.069
DO - 10.1016/j.jacc.2020.08.069
M3 - Article
C2 - 33121710
AN - SCOPUS:85092915671
SN - 0735-1097
VL - 76
SP - 2043
EP - 2055
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -