Increases in cardiac troponin indicative of myocardial injury may be common in patients with COVID-19 and associated with adverse outcomes such as arrhythmias and death, according to a paper published July 8 in the Journal of the American College of Cardiology.

Yader Sandoval, MD, FACC; James L. Januzzi Jr, MD, FACC; and Allan S. Jaffe, MD, FACC, summarize summarize the evolving understanding of myocardial injury and explain that the increases in cardiac troponin are more likely to occur in patients with chronic cardiovascular conditions and severe COVID-19. They add that increased inflammatory and prothrombotic responses following SARS-CoV-2 infection enhance the risk for acute nonischemic and acute myocardial infarction (MI), particularly type 2 MI.

The authors note that while myocarditis, stress cardiomyopathy, acute heart failure and direct injury from SARS-CoV-2 are important etiologies, primary noncardiac conditions such as pulmonary embolism, critical illness and sepsis probably cause more of the myocardial injury.

Furthermore, the authors explain that no established therapies exist for myocardial injury associated with COVID-19. In general, for patients with myocardial injury, the same concepts apply for patients with and without COVID-19. The authors stress that management decisions should be based on serial measurements that facilitate decision-making.

"The structured use of serial cardiac troponin testing has the potential to facilitate risk stratification, help make decisions about when to use imaging, and inform stage categorization and disease phenotyping among hospitalized COVID-19 patients," the authors conclude.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, COVID-19 Hub, Heart Failure and Cardiomyopathies, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: SARS Virus, COVID-19, Myocarditis, Takotsubo Cardiomyopathy, Critical Illness, severe acute respiratory syndrome coronavirus 2, Severe Acute Respiratory Syndrome, Sepsis, Myocardial Infarction, Cardiovascular Diseases, Pulmonary Embolism, Arrhythmias, Cardiac, Heart Failure, Decision Making

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