Myocardial Injury in Severe COVID-19 Compared to Non-COVID A
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Knowledge gaps remain in the epidemiology and clinical implications of myocardial injury in COVID-19. The goal of this study was to determine the prevalence and outcomes of myocardial injury in severe COVID-19 compared to acute respiratory distress syndrome (ARDS) unrelated to COVID-19.

Researchers included intubated COVID-19 patients from 5 hospitals between March 15 and June 11, 2020 with troponin levels assessed. They compared them to patients from a cohort study of myocardial injury in ARDS. They performed survival analysis with primary outcome of in-hospital death associated with myocardial injury and performed linear regression to identify clinical factors associated with myocardial injury in COVID-19.

Results:
-- Of 243 patients intubated with COVID-19, 51% had troponin levels greater than upper limit of normal (ULN).

-- Chronic kidney disease, lactate, ferritin and fibrinogen were associated with myocardial injury.

-- Mortality was 22.7% among COVID-19 patients with troponin less than ULN and 61.5% for those with troponin levels greater than 10xULN.

-- The association of myocardial injury with mortality was not statistically significant after adjusting for age, sex and multi-system organ dysfunction.

-- Compared to non-COVID ARDS patients, patients with COVID-19 were older with higher creatinine and less favorable vital signs.

-- After adjustment, COVID-19 was associated with lower odds of myocardial injury compared to non-COVID ARDS.

Conclusively, myocardial injury in severe COVID-19 is a function of baseline comorbidities, advanced age and multisystem organ dysfunction similar to traditional ARDS. The adverse prognosis of myocardial injury in COVID-19 relates largely to multisystem organ involvement and critical illness.

Source: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050543
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