Majority of COVID-19 Patients With Myocardial Injury Have Cardiac Structural Abnormalities

Cardiac structural abnormalities were present in nearly two-thirds of patients with COVID-19 and myocardial injury, according to a study published Oct. 26 in the Journal of the American College of Cardiology.

Gennaro Giustino, MD, et al., sought to identify the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19 by examining data from COVID-19 patients who underwent a transthoracic echocardiographic (TTE) evaluation during their hospitalization. The data was collected at seven clinical sites in New York City and Milan, Italy between March 5 and May 2, 2020.

Of the 305 patients included in the study, 190 patients (62.6%) had biomarker evidence of myocardial injury. Patients with myocardial injury had higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities, including left ventricular wall motion abnormalities, global left ventricular dysfunction and more.

Results showed the rate of in-hospital mortality was 5.2% in patients without myocardial injury; 18.6% in patients with myocardial injury without TTE; and 31.7% in patients with myocardial injury and TTE abnormalities.

"Myocardial injury is associated with increased risk of in-hospital mortality particularly in the presence of cardiac structural abnormalities detected by TTE," write the authors. They conclude that moving forward, "TTE evaluation should be considered in patients with COVID-19 and biomarker evidence of myocardial injury to characterize the underlying cardiac substrate, for risk stratification, and to potentially guide management strategies."

An accompanying editorial comment by Carl J. Lavie, MD, FACC, et al., notes that, "[There] is now evidence that Tn-positive COVID-19 patients may benefit from routine TTE, which would allow practitioners to garner useful prognostic information and to establish specific therapeutic options in patients with cardiac injury."

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound

Keywords: Hospital Mortality, Prevalence, Prognosis, New York City, COVID-19, severe acute respiratory syndrome coronavirus 2, Echocardiography, Heart Injuries, Heart Diseases, Heart, Cardiology, Hospitalization, Ventricular Dysfunction, Left, Biomarkers, Risk Assessment

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