Cardiac injury, as defined by an elevation in cardiac troponin, has been commonly reported in hospitalized patients with coronavirus disease 2019 (COVID-19). The following are 10 key points to remember on the use of cardiac troponin in COVID-19:

1. Elevation in cardiac troponin is noted in over 40% of patients with acute respiratory illnesses, COVID-19 or non-COVID related.
2. Levels of cardiac troponin vary widely in patients with COVID-19, but are considerably lower than that observed in acute myocardial infarctions.
3. Levels of cardiac troponin in COVID-19 correlate with disease severity, inflammatory and prothrombotic markers, older age, and the prevalence of cardiovascular disease and risk factors.
4. The mechanisms of myocardial injury in COVID-19 are likely both ischemic and nonischemic in nature and include decreased renal clearance, pulmonary emboli, myocarditis, stress cardiomyopathy, type 1 myocardial infarction, and demand ischemia. The differential contributions of these mechanisms are unknown.
5. Evidence on the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the myocardium is conflicting. Studies reporting intramyocardial viral proteome did not note significant coronary thrombi or typical findings of myocarditis.
6. Cardiac imaging can help identify the cause of myocardial injury. However, the risk of infection among health care personnel is problematic, precluding imaging except when clinical suspicion is high and the information obtained from imaging would be actionable.
7. Patients with evidence of myocardial injury are at higher risk of in-hospital mortality and arrhythmias in patients with COVID-19.
8. Serial measurements of cardiac troponin can facilitate decision making regarding determining the nature of myocardial injury (acute vs. chronic) and enhance prognostication.
9. Systematic testing of cardiac troponin should only be adopted in the setting of a clear strategy for interpretation of findings and subsequent management in order to avoid unnecessary downstream testing.
10. There are no data demonstrating benefits of specific treatment strategies in patients with COVID-19 and elevated troponin.

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention

Keywords: Coronavirus, COVID-19, Diagnostic Imaging, Heart Injuries, Hospital Mortality, Myocardial Infarction, Myocarditis, Myocardium, Proteome, Primary Prevention, Risk Factors, severe acute respiratory syndrome coronavirus 2, Takotsubo Cardiomyopathy, Troponin

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