Characterization of Myocardial Injury in Patients With COVID-19

Gennaro Giustino; Lori B. Croft; Giulio G. Stefanini; Renato Bragato; Jeffrey J. Silbiger; Marco Vicenzi; Tatyana Danilov; Nina Kukar; Nada Shaban; Annapoorna Kini; Anton Camaj; Solomon W. Bienstock; Eman R. Rashed; Karishma Rahman; Connor P. Oates; Samantha Buckley; Lindsay S. Elbaum; Derya Arkonac; Ryan Fiter; Ranbir Singh; Emily Li; Victor Razuk; Sam E. Robinson; Michael Miller; Benjamin Bier; Valeria Donghi; Marco Pisaniello; Riccardo Mantovani; Giuseppe Pinto; Irene Rota; Sara Baggio; Mauro Chiarito; Fabio Fazzari; Ignazio Cusmano; Mirko Curzi; Richard Ro; Waqas Malick; Mazullah Kamran; Roopa Kohli-Seth; Adel M. Bassily-Marcus; Eric Neibart; Gregory Serrao; Gila Perk; Donna Mancini; Vivek Y. Reddy; Sean P. Pinney; George Dangas; Francesco Blasi; Samin K. Sharma; Roxana Mehran; Gianluigi Condorelli; Gregg W. Stone; Valentin Fuster; Stamatios Lerakis; Martin E. Goldman

doi:10.1016/j.jacc.2020.08.069

Characterization of Myocardial Injury in Patients With COVID-19

Gennaro Giustino, Lori B. Croft, Giulio G. Stefanini, Renato Bragato, Jeffrey J. Silbiger, Marco Vicenzi, Tatyana Danilov, Nina Kukar, Nada Shaban, Annapoorna Kini, Anton Camaj, Solomon W. Bienstock, Eman R. Rashed, Karishma Rahman, Connor P. Oates, Samantha Buckley, Lindsay S. Elbaum, Derya Arkonac, Ryan Fiter, Ranbir SinghEmily Li, Victor Razuk, Sam E. Robinson, Michael Miller, Benjamin Bier, Valeria Donghi, Marco Pisaniello, Riccardo Mantovani, Giuseppe Pinto, Irene Rota, Sara Baggio, Mauro Chiarito, Fabio Fazzari, Ignazio Cusmano, Mirko Curzi, Richard Ro, Waqas Malick, Mazullah Kamran, Roopa Kohli-Seth, Adel M. Bassily-Marcus, Eric Neibart, Gregory Serrao, Gila Perk, Donna Mancini, Vivek Y. Reddy, Sean P. Pinney, George Dangas, Francesco Blasi, Samin K. Sharma, Roxana Mehran, Gianluigi Condorelli, Gregg W. Stone, Valentin Fuster, Stamatios Lerakis, Martin E. Goldman

Research output: Contribution to journal › Article › peer-review

212 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	2043-2055
Number of pages	13
Journal	Journal of the American College of Cardiology
Volume	76
Issue number	18
DOIs	https://doi.org/10.1016/j.jacc.2020.08.069
State	Published - 3 Nov 2020

Keywords

COVID-19
echocardiography
myocardial infarction
myocardial injury

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10.1016/j.jacc.2020.08.069

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Giustino, G., Croft, L. B., Stefanini, G. G., Bragato, R., Silbiger, J. J., Vicenzi, M., Danilov, T., Kukar, N., Shaban, N., Kini, A., Camaj, A., Bienstock, S. W., Rashed, E. R., Rahman, K., Oates, C. P., Buckley, S., Elbaum, L. S., Arkonac, D., Fiter, R., ... Goldman, M. E. (2020). Characterization of Myocardial Injury in Patients With COVID-19. Journal of the American College of Cardiology, 76(18), 2043-2055. https://doi.org/10.1016/j.jacc.2020.08.069

@article{953a07652d1a4c78b6b970dc2f8f114f,

title = "Characterization of Myocardial Injury in Patients With COVID-19",

abstract = "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.",

keywords = "COVID-19, echocardiography, myocardial infarction, myocardial injury",

author = "Gennaro Giustino and Croft, {Lori B.} and Stefanini, {Giulio G.} and Renato Bragato and Silbiger, {Jeffrey J.} and Marco Vicenzi and Tatyana Danilov and Nina Kukar and Nada Shaban and Annapoorna Kini and Anton Camaj and Bienstock, {Solomon W.} and Rashed, {Eman R.} and Karishma Rahman and Oates, {Connor P.} and Samantha Buckley and Elbaum, {Lindsay S.} and Derya Arkonac and Ryan Fiter and Ranbir Singh and Emily Li and Victor Razuk and Robinson, {Sam E.} and Michael Miller and Benjamin Bier and Valeria Donghi and Marco Pisaniello and Riccardo Mantovani and Giuseppe Pinto and Irene Rota and Sara Baggio and Mauro Chiarito and Fabio Fazzari and Ignazio Cusmano and Mirko Curzi and Richard Ro and Waqas Malick and Mazullah Kamran and Roopa Kohli-Seth and Bassily-Marcus, {Adel M.} and Eric Neibart and Gregory Serrao and Gila Perk and Donna Mancini and Reddy, {Vivek Y.} and Pinney, {Sean P.} and George Dangas and Francesco Blasi and Sharma, {Samin K.} and Roxana Mehran and Gianluigi Condorelli and Stone, {Gregg W.} and Valentin Fuster and Stamatios Lerakis and Goldman, {Martin E.}",

note = "Funding Information: The work was partly funded by a research grant on COVID-19 from Regione Lombardia Welfare. Dr. Giustino has received consulting fees for Advisory Board service from Bristol Myers Squibb/Pfizer. Dr. Stefanini has received institutional research grant support from Boston Scientific; and has received speaker/consultant fees from B. Braun, Biosensors International, and Boston Scientific. Dr. Silbiger has served on the Speakers Bureau for Lantheus Medical Imaging. Dr. Reddy has served as a consultant to Abbott, Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, AtaCor, Autonomix Medical, Axon, Backbeat, BioSig Technologies, Biosense Webster, Biotronik, Boston Scientific, CardioFocus, Cardionomic, CardioNXT/AFTx, Circa Scientific, Corvia Medical, East End Medical, EBR Systems, EP Dynamics, EPIX Therapeutics, EpiEP, Eximo Medical, Farapulse, Fire1, Impulse Dynamics, Javelin Medical, Keystone Heart, LuxCath, MedLumics, Medtronic, Middle Peak Medical, NuVera Medical, Philips, Sirona Medical, Stimda, Thermedical, Valcare Medical, and VytronUS; and holds equity in Ablacon, Acutus Medical, Affera, Apama, Aquaheart, AtaCor, Autonomix Medical, Backbeat, BioSig Technologies, Circa Scientific, Corvia Medical, East End Medical, EP Dynamics, EPIX Therapeutics, EpiEP, Eximo Medical, Farapulse, Fire1, Javelin Medical, Keystone Heart, LuxCath, Manual Surgical Sciences, MedLumics, Middle Peak Medical, NuVera Medical, Sirona Medical, sureCor, Valcare Medial, Vizara, and VytronUS. Dr. Dangas has received consulting fees and Advisory Board fees from AstraZeneca; has received consulting fees from Biosensors International; and has previously held stock in Medtronic. Dr. Mehran has received consulting fees from Abbott Vascular Laboratories, Boston Scientific, Medscape/WebMD, Siemens Medical Solutions, Phillips/Volcano/Spectranetics, Roivant Sciences, Sanofi Italy, Bracco Group, Janssen Pharmaceuticals, and AstraZeneca; has received grant support, paid to her institution, from Bayer, CSL Behring, DSI Medical, Medtronic, Novartis Pharmaceuticals, OrbusNeich, Osprey Medical, PLC/RenalGuard, and Abbott Vascular; has received grant support and Advisory Board fees, paid to her institution, from Bristol Myers Squibb; has received fees for serving on a Data and Safety Monitoring Board from Watermark Research Funding; has received Advisory Board fees and lecture fees from MedIntelligence (Janssen Pharmaceuticals); and has received lecture fees from Bayer. Dr. Stone has received speaker or other honoraria from Cook Group, Terumo, Qool Therapeutics, and Orchestra BioMed; has served as a consultant to VALFIX Medical, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore Medical, Ablative Solutions, Miracor Medical, Neovasc, V-Wave, Abiomed, Ancora Medical Technology, MAIA Pharmaceuticals, Vectorious Medical Technologies, REVA Medical, Matrizyme Pharma, and CardioMech; and has equity/options from Ancora, Qool Therapeutics, Cagent Vascular, Applied Therapeutics, BioStar Ventures family of funds, SpectraWAVE, Orchestra BioMed, Aria, Cardiac Success, MedFocus family of funds, and VALFIX Medical. Dr. Goldman has served on the Speakers Bureau for Lantheus Medical Imaging. All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: The work was partly funded by a research grant on COVID-19 from Regione Lombardia Welfare. Dr. Giustino has received consulting fees for Advisory Board service from Bristol Myers Squibb/Pfizer. Dr. Stefanini has received institutional research grant support from Boston Scientific; and has received speaker/consultant fees from B. Braun, Biosensors International, and Boston Scientific. Dr. Silbiger has served on the Speakers Bureau for Lantheus Medical Imaging. Dr. Reddy has served as a consultant to Abbott, Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, AtaCor, Autonomix Medical, Axon, Backbeat, BioSig Technologies, Biosense Webster, Biotronik, Boston Scientific, CardioFocus, Cardionomic, CardioNXT/AFTx, Circa Scientific, Corvia Medical, East End Medical, EBR Systems, EP Dynamics, EPIX Therapeutics, EpiEP, Eximo Medical, Farapulse, Fire1, Impulse Dynamics, Javelin Medical, Keystone Heart, LuxCath, MedLumics, Medtronic, Middle Peak Medical, NuVera Medical, Philips, Sirona Medical, Stimda, Thermedical, Valcare Medical, and VytronUS; and holds equity in Ablacon, Acutus Medical, Affera, Apama, Aquaheart, AtaCor, Autonomix Medical, Backbeat, BioSig Technologies, Circa Scientific, Corvia Medical, East End Medical, EP Dynamics, EPIX Therapeutics, EpiEP, Eximo Medical, Farapulse, Fire1, Javelin Medical, Keystone Heart, LuxCath, Manual Surgical Sciences, MedLumics, Middle Peak Medical, NuVera Medical, Sirona Medical, sureCor, Valcare Medial, Vizara, and VytronUS. Dr. Dangas has received consulting fees and Advisory Board fees from AstraZeneca; has received consulting fees from Biosensors International; and has previously held stock in Medtronic. Dr. Mehran has received consulting fees from Abbott Vascular Laboratories, Boston Scientific, Medscape/WebMD, Siemens Medical Solutions, Phillips/Volcano/Spectranetics, Roivant Sciences, Sanofi Italy, Bracco Group, Janssen Pharmaceuticals, and AstraZeneca; has received grant support, paid to her institution, from Bayer, CSL Behring, DSI Medical, Medtronic, Novartis Pharmaceuticals, OrbusNeich, Osprey Medical, PLC/RenalGuard, and Abbott Vascular; has received grant support and Advisory Board fees, paid to her institution, from Bristol Myers Squibb; has received fees for serving on a Data and Safety Monitoring Board from Watermark Research Funding; has received Advisory Board fees and lecture fees from MedIntelligence (Janssen Pharmaceuticals); and has received lecture fees from Bayer. Dr. Stone has received speaker or other honoraria from Cook Group, Terumo, Qool Therapeutics, and Orchestra BioMed; has served as a consultant to VALFIX Medical, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore Medical, Ablative Solutions, Miracor Medical, Neovasc, V-Wave, Abiomed, Ancora Medical Technology, MAIA Pharmaceuticals, Vectorious Medical Technologies, REVA Medical, Matrizyme Pharma, and CardioMech; and has equity/options from Ancora, Qool Therapeutics, Cagent Vascular, Applied Therapeutics, BioStar Ventures family of funds, SpectraWAVE, Orchestra BioMed, Aria, Cardiac Success, MedFocus family of funds, and VALFIX Medical. Dr. Goldman has served on the Speakers Bureau for Lantheus Medical Imaging. All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",

year = "2020",

month = nov,

day = "3",

doi = "10.1016/j.jacc.2020.08.069",

language = "English",

volume = "76",

pages = "2043--2055",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "18",

}

Giustino, G, Croft, LB, Stefanini, GG, Bragato, R, Silbiger, JJ, Vicenzi, M, Danilov, T, Kukar, N, Shaban, N, Kini, A, Camaj, A, Bienstock, SW, Rashed, ER, Rahman, K, Oates, CP, Buckley, S, Elbaum, LS, Arkonac, D, Fiter, R, Singh, R, Li, E, Razuk, V, Robinson, SE, Miller, M, Bier, B, Donghi, V, Pisaniello, M, Mantovani, R, Pinto, G, Rota, I, Baggio, S, Chiarito, M, Fazzari, F, Cusmano, I, Curzi, M, Ro, R, Malick, W, Kamran, M , Kohli-Seth, R , Bassily-Marcus, AM, Neibart, E, Serrao, G, Perk, G, Mancini, D, Reddy, VY, Pinney, SP , Dangas, G, Blasi, F, Sharma, SK , Mehran, R, Condorelli, G, Stone, GW, Fuster, V, Lerakis, S & Goldman, ME 2020, 'Characterization of Myocardial Injury in Patients With COVID-19', Journal of the American College of Cardiology, vol. 76, no. 18, pp. 2043-2055. https://doi.org/10.1016/j.jacc.2020.08.069

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 - Funding Information: The work was partly funded by a research grant on COVID-19 from Regione Lombardia Welfare. Dr. Giustino has received consulting fees for Advisory Board service from Bristol Myers Squibb/Pfizer. Dr. Stefanini has received institutional research grant support from Boston Scientific; and has received speaker/consultant fees from B. Braun, Biosensors International, and Boston Scientific. Dr. Silbiger has served on the Speakers Bureau for Lantheus Medical Imaging. Dr. Reddy has served as a consultant to Abbott, Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, AtaCor, Autonomix Medical, Axon, Backbeat, BioSig Technologies, Biosense Webster, Biotronik, Boston Scientific, CardioFocus, Cardionomic, CardioNXT/AFTx, Circa Scientific, Corvia Medical, East End Medical, EBR Systems, EP Dynamics, EPIX Therapeutics, EpiEP, Eximo Medical, Farapulse, Fire1, Impulse Dynamics, Javelin Medical, Keystone Heart, LuxCath, MedLumics, Medtronic, Middle Peak Medical, NuVera Medical, Philips, Sirona Medical, Stimda, Thermedical, Valcare Medical, and VytronUS; and holds equity in Ablacon, Acutus Medical, Affera, Apama, Aquaheart, AtaCor, Autonomix Medical, Backbeat, BioSig Technologies, Circa Scientific, Corvia Medical, East End Medical, EP Dynamics, EPIX Therapeutics, EpiEP, Eximo Medical, Farapulse, Fire1, Javelin Medical, Keystone Heart, LuxCath, Manual Surgical Sciences, MedLumics, Middle Peak Medical, NuVera Medical, Sirona Medical, sureCor, Valcare Medial, Vizara, and VytronUS. Dr. Dangas has received consulting fees and Advisory Board fees from AstraZeneca; has received consulting fees from Biosensors International; and has previously held stock in Medtronic. Dr. Mehran has received consulting fees from Abbott Vascular Laboratories, Boston Scientific, Medscape/WebMD, Siemens Medical Solutions, Phillips/Volcano/Spectranetics, Roivant Sciences, Sanofi Italy, Bracco Group, Janssen Pharmaceuticals, and AstraZeneca; has received grant support, paid to her institution, from Bayer, CSL Behring, DSI Medical, Medtronic, Novartis Pharmaceuticals, OrbusNeich, Osprey Medical, PLC/RenalGuard, and Abbott Vascular; has received grant support and Advisory Board fees, paid to her institution, from Bristol Myers Squibb; has received fees for serving on a Data and Safety Monitoring Board from Watermark Research Funding; has received Advisory Board fees and lecture fees from MedIntelligence (Janssen Pharmaceuticals); and has received lecture fees from Bayer. Dr. Stone has received speaker or other honoraria from Cook Group, Terumo, Qool Therapeutics, and Orchestra BioMed; has served as a consultant to VALFIX Medical, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore Medical, Ablative Solutions, Miracor Medical, Neovasc, V-Wave, Abiomed, Ancora Medical Technology, MAIA Pharmaceuticals, Vectorious Medical Technologies, REVA Medical, Matrizyme Pharma, and CardioMech; and has equity/options from Ancora, Qool Therapeutics, Cagent Vascular, Applied Therapeutics, BioStar Ventures family of funds, SpectraWAVE, Orchestra BioMed, Aria, Cardiac Success, MedFocus family of funds, and VALFIX Medical. Dr. Goldman has served on the Speakers Bureau for Lantheus Medical Imaging. All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: The work was partly funded by a research grant on COVID-19 from Regione Lombardia Welfare. Dr. Giustino has received consulting fees for Advisory Board service from Bristol Myers Squibb/Pfizer. Dr. Stefanini has received institutional research grant support from Boston Scientific; and has received speaker/consultant fees from B. Braun, Biosensors International, and Boston Scientific. Dr. Silbiger has served on the Speakers Bureau for Lantheus Medical Imaging. Dr. Reddy has served as a consultant to Abbott, Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, AtaCor, Autonomix Medical, Axon, Backbeat, BioSig Technologies, Biosense Webster, Biotronik, Boston Scientific, CardioFocus, Cardionomic, CardioNXT/AFTx, Circa Scientific, Corvia Medical, East End Medical, EBR Systems, EP Dynamics, EPIX Therapeutics, EpiEP, Eximo Medical, Farapulse, Fire1, Impulse Dynamics, Javelin Medical, Keystone Heart, LuxCath, MedLumics, Medtronic, Middle Peak Medical, NuVera Medical, Philips, Sirona Medical, Stimda, Thermedical, Valcare Medical, and VytronUS; and holds equity in Ablacon, Acutus Medical, Affera, Apama, Aquaheart, AtaCor, Autonomix Medical, Backbeat, BioSig Technologies, Circa Scientific, Corvia Medical, East End Medical, EP Dynamics, EPIX Therapeutics, EpiEP, Eximo Medical, Farapulse, Fire1, Javelin Medical, Keystone Heart, LuxCath, Manual Surgical Sciences, MedLumics, Middle Peak Medical, NuVera Medical, Sirona Medical, sureCor, Valcare Medial, Vizara, and VytronUS. Dr. Dangas has received consulting fees and Advisory Board fees from AstraZeneca; has received consulting fees from Biosensors International; and has previously held stock in Medtronic. Dr. Mehran has received consulting fees from Abbott Vascular Laboratories, Boston Scientific, Medscape/WebMD, Siemens Medical Solutions, Phillips/Volcano/Spectranetics, Roivant Sciences, Sanofi Italy, Bracco Group, Janssen Pharmaceuticals, and AstraZeneca; has received grant support, paid to her institution, from Bayer, CSL Behring, DSI Medical, Medtronic, Novartis Pharmaceuticals, OrbusNeich, Osprey Medical, PLC/RenalGuard, and Abbott Vascular; has received grant support and Advisory Board fees, paid to her institution, from Bristol Myers Squibb; has received fees for serving on a Data and Safety Monitoring Board from Watermark Research Funding; has received Advisory Board fees and lecture fees from MedIntelligence (Janssen Pharmaceuticals); and has received lecture fees from Bayer. Dr. Stone has received speaker or other honoraria from Cook Group, Terumo, Qool Therapeutics, and Orchestra BioMed; has served as a consultant to VALFIX Medical, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore Medical, Ablative Solutions, Miracor Medical, Neovasc, V-Wave, Abiomed, Ancora Medical Technology, MAIA Pharmaceuticals, Vectorious Medical Technologies, REVA Medical, Matrizyme Pharma, and CardioMech; and has equity/options from Ancora, Qool Therapeutics, Cagent Vascular, Applied Therapeutics, BioStar Ventures family of funds, SpectraWAVE, Orchestra BioMed, Aria, Cardiac Success, MedFocus family of funds, and VALFIX Medical. Dr. Goldman has served on the Speakers Bureau for Lantheus Medical Imaging. All the other authors have reported that they have no relationships relevant to the contents of this paper to disclose. 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 -

Characterization of Myocardial Injury in Patients With COVID-19

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Keywords

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