Admission troponin levels were associated with disease severity and recent cardiac injury shown by MRI in Covid-19 inpatients

ABSTRACT

Background and Aim: Troponin and some inflammation biomarkers were associated with Covid-19 severity and intensive care unit (ICU) admissions related with cardiac injury. But cardiac magnetic resonance imaging (CMRI) remains to be the gold standard for revealing myocardial involvement. In this study, we aim to investigate whether admission troponin levels were associated with both clinical severity and cardiac injury shown using CMRI. Method(s) The study sample consisted of 51 recovered patients who had needed in-hospital follow-up, either in COVID-19 ICU (Group 1, n=16) and COVID-19 clinics (Group 2, n=35). Hs-cTnT, CRP, PCT, NLR, D-dimer, ferritin levels and SII and were measured at admission to hospital. All of these participants were referred to electrocardiography (ECG), transthoracic echocardiography (TTE) and CMRI simultaneously on an average of 4-6 weeks after discharge. Study groups were compared according to these findings. Result(s) Among study population, 25 patients (49%) had SARS-CoV-2 variants, including the Alpha variant [n=16, (31%)], the Beta [n=5, (10%)] and the Delta variant [n=4, (8%)]. Respiratory distress as initial symptom was higher in group 1 compared to group 2. Group 1 had higher respiratory rate, lower SpO2 levels and higher supplemental oxygen requirement compared with group 2, which would explain respiratory distress. Hs-cTnT levels and inflammatory biomarkers were significantly higher in ICU patients (p<0.05). ROC curve revealed significant correlation between Hs-cTnT, NLR, D-dimer, ferritin, CRP, SII levels and ICU admission (p<0.05) (Figure 1). ECG and TTE features of groups were similar. Functional parameters were also similar for both groups in CMRI findings. But, a total of 32 patients had any kind of injury on CMRI, including at least one of the following myocardial oedema (n=7), pericardial effusion (n=13) and right ventricular failure (n=12), ischemic (n=8) or non-ischemic fibrosis (n=27) on late gadolinium enhancement imaging. CMRI images of various myocardial injury patterns were shown in Figure 2. There was a significant difference between patients who followed up in Group 1 vs. Group 2 for non-ischemic fibrosis [n=12 (75%) vs. n=15 (43%);p=0.03]. ICU patients had more common non-ischemic fibrosis on CMRI (p=0.03). ROC curve exposed a significant correlation between Hs-cTnT and SII levels with any injury shown on CMRI (p<0.05) (Figure 3). Conclusion(s) Admission troponin and SII levels were associated with disease severity and cardiac injury shown by CMRI even if echocardiographic evaluation is normal. Both of them could be used to have an idea about both the need of ICU and serious cardiac involvement. (Figure Presented).