Cardiac damage in covid-19: An undertreated threat to survival

ABSTRACT

Introduction: Cardiac injury occurs in about 20-30% of patients hospitalized for COVID-19 and influence the prognosis but many aspects like the role of age and magnitude of cardiac damage in determining the prognosis, remains vague. Hypothesis: Age and magnitude of cardiac damage may influence the mortality of patients hospitalized for COVID-19. Methods: We considered all patients consecutively admitted at a third-level European Hospital for COVID-19 between February and June 2020. Cardiac injury was defined as a high-sensitivity cardiac Troponin I (hs-cTnI) value greater than the upper reference limit (URL) of 47 ng/dL. Firstly, we analyzed the data by hs-cTnI across age tertiles (<62 years, 62-73 years and >73 years). Then, we compared patients with no-damage, mid-damage (hs-cTnI up to 10-fold URL) and high-damage (more than 10-fold URL). The primary endpoint was in-hospital mortality. Results: We enrolled 543 patients (median age 69, 67% males);hs-cTnI was available in 509. The survival was lower in elderly patients and high levels of hs-cTnI worsened the prognosis across all age tertiles (Fig. 1A). Surprisingly, the magnitude of cardiac damage did not influence the overall in-hospital mortality (Fig. 1B), but patients with high-damage died earlier (survival at 15 days 86% nodamage vs 61% mid-damage vs 49% high-damage;p<0.001). Of note, among patients with highdamage, only 7 received coronary angiography, cardiac magnetic resonance or heart biopsy. Conclusions: Cardiac injury dramatically increased the mortality across all ages in patients hospitalized for COVID-19. The magnitude of cardiac damage did not influence overall in-hospital mortality but almost all patients with high-damage died within 15 days from admission. A secondlevel diagnostic test was performed seldomly in high-damage patients, suggesting that the unexpected high burden of the first COVID-19 wave negatively influenced the health system and our clinical daily practice.