From the Guidelines
Coronavirus disease (COVID-19) is associated with myocardial injury, as indicated by troponin elevation, which is a significant predictor of mortality.
Relationship between COVID-19 and Troponin Elevation
- The relationship between COVID-19 and troponin elevation is well-established, with studies showing that approximately 10% to 20% of hospitalized patients with COVID-19 have evidence of myocardial injury, as indicated by elevated troponin levels 1.
- Elevated troponin levels are associated with increased mortality in patients with COVID-19, with one study showing that troponin values greater than 100 are associated with increased mortality 1.
- The mechanisms underlying myocardial injury in COVID-19 are multifactorial and include activation of inflammatory and thrombotic cascades, direct viral injury to myocytes or vascular endothelium, and worsening of underlying baseline atherosclerotic and structural abnormalities 1.
Clinical Implications
- The presence of elevated troponin levels in patients with COVID-19 should prompt closer monitoring for potential deterioration and consideration of cardiology consultation 1.
- A multiparametric approach to evaluation, including electrocardiogram (ECG), measurement of cardiac troponin (cTn), and echocardiogram, is recommended for patients with suspected cardiac involvement 1.
- Cardiac magnetic resonance (CMR) imaging is recommended for patients with suspected myocardial involvement who are hemodynamically stable, as it is the most sensitive method to exclude ischemia and preexisting cardiomyopathies 1.
From the Research
Relationship between COVID-19 and Troponin Elevation
The relationship between Coronavirus disease (COVID-19) and troponin elevation, indicating myocardial injury, has been studied extensively.
- Elevated troponin levels have been found to be associated with increased mortality and adverse outcomes in patients with COVID-19 2, 3, 4, 5, 6.
- Myocardial injury, characterized by elevated cardiac troponin, is a common finding in COVID-19 patients and is strongly associated with severity 4.
- The prevalence of elevated troponin levels in COVID-19 patients has been reported to be around 26.9% to 30.0% 4.
- Elevated troponin levels have been found to be an independent predictor of 30-day mortality in COVID-19 patients, irrespective of cardiac troponin assay and cut-offs to detect myocardial injury 4.
- The measurement of troponin has been found to be useful for risk stratification in COVID-19 patients, with a remarkable negative predictive value 6.
Mechanisms and Outcomes
- The possible mechanisms of myocardial injury in COVID-19 patients include direct viral infection, inflammation, and hypoxia 5.
- Elevated troponin levels have been associated with increased mortality, intensive care unit admission, and worse prognosis in COVID-19 patients 2, 3, 6.
- The role of troponin as a risk predictor for COVID-19 patients has been supported by several studies, with a significant association between troponin elevation and in-hospital mortality 2, 3, 6.
Clinical Implications
- The early measurement of cardiac troponin may be useful for risk stratification in COVID-19 patients 4.
- Troponin measurement has been found to be important for identifying patients with myocardial injury and predicting adverse outcomes 6.
- The use of troponin as a biomarker may help clinicians to identify high-risk patients and provide targeted treatment and management 2, 3, 6.