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 | |
State | Published - 3 Nov 2020 |
Keywords
- COVID-19
- echocardiography
- myocardial infarction
- myocardial injury
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In: Journal of the American College of Cardiology, Vol. 76, No. 18, 03.11.2020, p. 2043-2055.
Research output: Contribution to journal › Article › peer-review
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 -