Cardiac function in relation to myocardial injury in hospitalised patients with COVID-19

• Published in: Netherlands heart journal Vol. 28; no. 7-8; pp. 410 - 417
• Main Authors: van den Heuvel, F. M. A., Vos, J. L., Koop, Y., van Dijk, A. P. J., Duijnhouwer, A. L., de Mast, Q., van de Veerdonk, F. L., Bosch, F., Kok, B., Netea, M. G., Hoogerwerf, J., Hoefsloot, W., Tjwa, E. T. T. L., de Korte, C. L., van Kimmenade, R. R. J., Nijveldt, R.
• Format: Journal Article
• Language: English
• Published: Houten Bohn Stafleu van Loghum 01.07.2020; Springer Nature B.V
• Subjects: Biomarkers; Body mass index; Cardiac function; Cardiology; Cardiovascular disease; Chronic obstructive pulmonary disease; Coronary vessels; Coronaviruses; COVID-19; Diabetes; Disease transmission; Heart attacks; Heart failure; Hypertension; Infectious diseases; Intensive care; Laboratories; Medical Education; Medicine; Medicine & Public Health; Original; Original Article; Patients; Peptides; Polymerase chain reaction; Pulmonary arteries; Respiratory diseases; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Tomography; Ultrasonic imaging; Netherlands; COVID-19; Troponin; Echocardiography; NT-proBNP; SARS-CoV‑2; Global longitudinal strain; Ultrasound; Myocardial injury
• ISSN: 1568-5888; 1876-6250
• DOI: 10.1007/s12471-020-01458-2

Background Previous studies have reported on myocardial injury in patients with coronavirus infectious disease 19 (COVID-19) defined as elevated cardiac biomarkers. Whether elevated biomarkers truly represent myocardial dysfunction is not known. The aim of this study was to explore the incidence of ventricular dysfunction and assess its relationship with biomarker analyses. Methods This cross-sectional study ran from April 1 to May 12, 2020, and consisted of all consecutively admitted patients to the Radboud university medical centre nursing ward for COVID-19. Laboratory assessment included high-sensitivity Troponin T and N‑terminal pro-B-type natriuretic peptide (NT-proBNP). Echocardiographic evaluation focused on left and right ventricular systolic function and global longitudinal strain (GLS). Results In total, 51 patients were included, with a median age of 63 years (range 51–68 years) of whom 80% was male. Troponin T was elevated (>14 ng/l) in 47%, and a clinically relevant Troponin T elevation (10 × URL) was found in three patients (6%). NT-proBNP was elevated (>300 pg/ml) in 24 patients (47%), and in four (8%) the NT-proBNP concentration was >1,000 pg/ml. Left ventricular dysfunction (ejection fraction <52% and/or GLS >−18%) was observed in 27%, while right ventricular dysfunction (TAPSE <17 mm and/or RV S’ < 10 cm/s) was seen in 10%. There was no association between elevated Troponin T or NT-proBNP and left or right ventricular dysfunction. Patients with confirmed pulmonary embolism had normal right ventricular function. Conclusions In hospitalised patients, it seems that COVID-19 predominantly affects the respiratory system, while cardiac dysfunction occurs less often. Based on a single echocardiographic evaluation, we found no relation between elevated Troponin T or NT-proBNP, and ventricular dysfunction. Echocardiography has limited value in screening for ventricular dysfunction.