Author + information
- Received May 18, 2020
- Accepted June 2, 2020
- Published online June 8, 2020.
- Anuradha Lala, MD1,2,#∗ (, )
- Kipp W. Johnson, PhD3,4,∗,
- James L. Januzzi, MD5,6,
- Adam J. Russak, MD3,7,
- Ishan Paranjpe, BS3,
- Felix Richter, PhD3,4,
- Shan Zhao, MD PhD3,8,
- Sulaiman Somani, BS3,
- Tielman Van Vleck, PhD3,
- Akhil Vaid, MD3,4,
- Fayzan Chaudhry, MS3,
- Jessica K. De Freitas, BS3,4,
- Zahi A. Fayad, PhD9,10,
- Sean P. Pinney, MD1,
- Matthew Levin, MD2,4,11,12,
- Alexander Charney, MD PhD4,13,
- Emilia Bagiella, PhD1,2,
- Jagat Narula, MD PhD1,
- Benjamin S. Glicksberg, PhD3,4,11,
- Girish Nadkarni, MD MPH3,7,15,
- Donna M. Mancini, MD1,2,+,
- Valentin Fuster, MD PhD1,+,
- on behalf of the Mount Sinai Covid Informatics Center
- 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai
- 2Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
- 3The Hasso Plattner Institute for Digital Health at Mount Sinai
- 4Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai
- 5Division of Cardiology, Department of Medicine, Massachusetts General Hospital
- 6Baim Institute for Clinical Research, Cardiometabolic Trials
- 7Department of Medicine, Icahn School of Medicine at Mount Sinai
- 8Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai
- 9The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai
- 10Department of Radiology, Icahn School of Medicine at Mount Sinai
- 11Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai
- 12Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai
- 13The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai
- 15The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai
- ↵#Correspondence: Anuradha Lala 1 Gustave Levy Place, Box 1030 New York, NY 10029 (P) 212-241-7300 (F) 212-241-5006
Background The degree of myocardial injury, as reflected by troponin elevation, and associated outcomes among US hospitalized patients with Coronavirus Disease 2019 (COVID-19) are unknown.
Objectives To describe the degree of myocardial injury and associated outcomes in a large hospitalized cohort with laboratory-confirmed COVID-19.
Methods Patients with COVID-19 admitted to one of five Mount Sinai Health System hospitals in New York City between February 27th and April 12th, 2020 with troponin-I (normal value <0.03ng/mL) measured within 24 hours of admission were included (n=2,736). Demographics, medical history, admission labs, and outcomes were captured from the hospitals’ EHR.
Results The median age was 66.4 years, with 59.6% men. Cardiovascular disease (CVD) including coronary artery disease, atrial fibrillation, and heart failure, was more prevalent in patients with higher troponin concentrations, as were hypertension and diabetes. A total of 506 (18.5%) patients died during hospitalization. In all, 985 (36%) patients had elevated troponin concentrations. After adjusting for disease severity and relevant clinical factors, even small amounts of myocardial injury (e.g. troponin I 0.03-0.09ng/mL, n=455, 16.6%) were significantly associated with death (adjusted HR: 1.75, 95% CI 1.37-2.24; P<0.001) while greater amounts (e.g. troponin I>0.09 ng/dL, n=530, 19.4%) were significantly associated with higher risk (adjusted HR 3.03, 95% CI 2.42-3.80; P<0.001).
Conclusions Myocardial injury is prevalent among patients hospitalized with COVID-19 however troponin concentrations were generally present at low levels. Patients with CVD are more likely to have myocardial injury than patients without CVD. Troponin elevation among patients hospitalized with COVID-19 is associated with higher risk of mortality.
↵∗ These authors contributed equally
↵+ These authors contributed equally and jointly supervised this work
14The Department of Psychiatry, Icahn School of Medicine at Mount Sinai
Funding: This work was Supported by U54 TR001433-05, National Center for Advancing Translational Sciences, National Institutes of Health.
Disclosures/Conflict of Interest:
Dr. James Januzzi is a Trustee of the American College of Cardiology, has received grant support from Novartis Pharmaceuticals and Abbott Diagnostics, consulting income from Abbott, Janssen, Novartis, MyoKardia and Roche Diagnostics, and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, CVRx, Janssen, and Takeda.
Dr. Sean Pinney has received consulting fees from Abbott, CareDx, Medtronic and Procyrion.
Dr. Zahi Fayad discloses consulting fees from Alexion and GlaxoSmithKline; Research funding from Daiichi Sankyo; Amgen; Bristol Myers Squibb; Siemens Healthineers. ZAF receives financial compensation as a board member and advisor to Trained Therapeutix Discovery and owns equity in Trained Therapeutix Discovery as co-founder.
Dr. Girish Nadkarni discloses consulting fees from AstraZeneca, Reata, BioVie, and GLG consulting. GNN receives financial compensation as a scientific board member and advisor to RenalytixAI and owns equity in RenalytixAI as co-founder. GNN also owns equity in Pensieve Health as a co-founder.
Dr. Kipp Johnson receives personal fees from Tempus Labs, Inc and holds equity in Tempus Labs, Inc. and Oova, Inc.
Dr. Tielman Van Vleck receives financial compensation as a consultant for Clinithink, LTD, the developer of the natural language processing software utilized in this study. Dr. Van Vleck also owns equity in Clinithink, a privately traded company.
Dr. Lala has received speaker honoraria from Zoll.
All other authors have nothing to disclose.
- Received May 18, 2020.
- Accepted June 2, 2020.