Author + information
- 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- 2Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, USA
- 3Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- ↵∗Address for correspondence:
Allan S. Jaffe, M.D. Department of Cardiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 Phone: 507-284-1648. Fax: 507-266-0228 Handles: @yadersandoval @JJheart_doc
⁃ Increases in cardiac troponin indicative of myocardial injury are common and prognostic in COVID-19.
⁃ Increases can be due to chronic injury, acute nonischemic injury, or acute myocardial infarction.
⁃ Troponin, along with inflammatory and thrombotic markers, may facilitate COVID-19 stage classification and risk-stratification.
Increases in cardiac troponin (cTn) indicative of myocardial injury are common in patients with COVID-19 and associated with adverse outcomes such as arrhythmias and death. These increases are more likely to occur in those with chronic cardiovascular conditions and in those with severe COVID-19 presentations. The increased inflammatory, prothrombotic, and procoagulant responses following SARS-CoV-2 infection increase the risk for acute nonischemic myocardial injury and acute myocardial infarction, particularly type 2 myocardial infarction because of respiratory failure with hypoxia and hemodynamic instability in critically ill patients. Myocarditis, stress cardiomyopathy, acute heart failure, and direct injury from SARS-CoV-2 are important etiologies, but primary non-cardiac conditions such as pulmonary embolism, critical illness, and sepsis probably cause more of the myocardial injury. The structured use of serial cTn 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.
Disclosures: Dr. Sandoval has served on the Advisory Boards for Roche Diagnostics (past) and Abbott Diagnostics without personal compensation. He has also been a speaker without personal financial compensation for Abbott Diagnostics.
Dr. Januzzi is a Trustee of the American College of Cardiology, has received grant support from Novartis Pharmaceuticals and Abbott Diagnostics, consulting income from Abbott Diagnostics, Janssen, MyoKardia, Novartis, and Roche Diagnostics, and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, Bayer, CVRx, Janssen, and Takeda. Dr. Jaffe has consulted or presently consults for most of the major diagnostics companies, including Beckman, Abbott, Siemens, ET Healthcare, Roche, Quidel, Sphingotec, Brava, Blade and Novartis.
Tweet (150 characters): Troponin increases, due to chronic myocardial injury, acute nonischemic myocardial injury or type 1 or 2 MI, are common in COVID-19 and associated with adverse outcomes.
- Received April 24, 2020.
- Revision received June 8, 2020.
- Accepted June 17, 2020.