ABSTRACT
Background/Introduction: Myocardial injury is a complication of coronavirus disease 2019 (COVID-19). Purpose: We sought to describe a large multi-centre experience of COVID-19 patients with myocardial injury, examining the prognostic role left ventricular function plays on short-term outcomes. Methods: We included adult COVID-19 patients admitted to our health system with evidence of myocardial injury and who underwent a transthoracic echocardiogram (TTE) during index admission. Patients were dichotomized into those with reduced ejection fraction (EF;<50%) and preserved EF (>50%). Results: Across our 11-hospital system, 5032 adult patients were admitted with COVID-19 from March-September 2020. Of these, 235 had evidence of myocardial injury (troponin >1 ng/mL). Included were 134 patients who underwent TTE, of whom 43.3% (n=58) had reduced EF and 56.7% (n=76) preserved EF (Figure 1). A subset of 6 patients had newly reduced EF, with 5 demonstrating evidence of stress cardiomyopathy and subsequently dying. Overall, mortality was high in those with reduced EF and preserved EF (in-hospital: 34.5% vs. 28.9%;p=0.494;6 months: 63.6% vs. 50.0%;p=0.167;Kaplan-Meier estimates: p=0.2886). Readmissions were frequent in both groups (30 days: 22.2% vs. 26.0%;p=0.162;6 months: 52.0% vs. 54.5%;p=0.839) (Figure 2). Conclusions: Many COVID-19 patients admitted with evidence of myocardial injury did not undergo TTE. For those who did, short-term mortality was high. Patients who survived hospitalisation had frequent readmissions. In patients with newly reduced EF, most had evidence of stress cardiomyopathy and expired. Larger studies are needed to fully evaluate the prognosis of COVID-19 patients with evidence of myocardial injury and left ventricular dysfunction.
ABSTRACT
Background: Cardiac involvement in coronavirus disease 2019 (COVID- 19) has been established. This is manifested by troponin elevation, and associated with worse prognosis as compared with patients without myocardial injury. Purpose: We sought to evaluate if the outcomes of these patients has improved as experience accumulated during the pandemic. Methods: We analyzed COVID-19-positive patients with the evidence of myocardial injury (defined as troponin elevation) who presented to our large US healthcare system in the northeast region during the Early Phase of the pandemic (March 1-June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the Current Phase of the pandemic (October 1, 2020-January 31, 2021). Results: The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the Early Phase and 621 during the Current Phase. The cohort's mean age was 70.2±14.9 years;54.3% were men (Figure 1). Maximum troponin-I in the Early Phase was 13.46±34.72 versus 11.21±20.57 in the Current Phase (p=0.553) In-hospital mortality was significantly higher (50.3%) in the Early Phase group compared to the Current Phase group (24.6%;p<0.001). Similarly, the incidence of intensive care unit admission (77.8% versus 46.1%;p<0.044) and requirement for mechanical ventilation (61.7% versus 28%;p<0.001) were higher in the Early Phase (Figure 2). In addition, 6% of those in the Early Phase underwent coronary angiography compared to 2.3% in the Current Phase (p=0.013). Finally, 3% of Early Phase and 0.8% of Current Phase patients underwent percutaneous coronary intervention (p=0.025). Conclusions: Treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies and provider experience.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) has demonstrated deleterious effects on the cardiovascular system, which is associated with worse outcomes. Myocardial injury in COVID-19 is common and, coupled with a reduction in ejection fraction (EF), is concerning for myocarditis. We sought to investigate the outcomes of COVID-19 patients with evidence of myocardial injury and a reduced ejection fraction. Methods: This was a retrospective observational study in which we screened COVID-19-positive patients who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) since the beginning of the COVID-19 pandemic (March-September 2020). We compared patients with a positive troponin (defined as >1.0 ng/mL) and reduced EF (<50%) to those with preserved EF (>50%) examining inpatient outcomes. Results: There were 3386 COVID-19-positive patients admitted to the MedStar system from March through September 2020 in whom a troponin was drawn. Of these, 195 patients had a positive troponin, of whom 105 had a transthoracic echocardiogram (TTE) during admission. There were 41 COVID-19-positive patients with a positive troponin and a reduced EF and 64 COVID-19-positive patients with a positive troponin and a preserved EF (32.4% vs. 60.2%;p=0.0001). Patients with a reduced EF saw higher maximum troponins during their admission (28.1 ng/mL vs. 5.6 ng/mL;p=0.0104), but similar rates of requiring intubation (58.5% vs. 57.8%;p=1.0000), intensive-care-unit length of stay (ICU LOS) (9.4 days vs. 12.1 days;p=0.2978) and inpatient mortality (36.6% vs. 31.3%;p=0.6721). Conclusions: COVID-19 patients with evidence of myocardial injury and reduced EF have higher troponin elevations compared to those with preserved EF but demonstrate similar dismal inpatient outcomes regardless of EF with higher rates of requiring intubation, prolonged ICU LOS, and an inpatient mortality >30%.