Myocardial injury may be fatal in COVID-19

Among patients with COVID-19, acute myocardial injury occurs commonly, especially in the elderly with pre-existing cardiovascular disease, and is tied to poor prognosis, a study has found.

Researchers looked at the medical records, laboratory results, chest CT images, and medication use in a cohort of 101 patients (median age, 49 years) presenting to two designated COVID-19 treatment centres in Sichuan, China.

Sixteen patients (15.8 percent) had evidence of acute myocardial injury (high-sensitivity troponin T [hs-TnT] >14 pg/mL), with nearly half of them having hs-TnT levels fivefold greater than the normal upper limit.

Patients with vs without acute myocardial injury were older, had a higher prevalence of pre-existing cardiovascular disease (eg, hypertension, coronary artery disease, and cerebrovascular disease), presented with more significant dyspnoea, and were more frequently treated with ACE inhibitor, angiotensin II receptor blocker (ARB), or calcium channel blocker (CCB).

Furthermore, patients with cardiac injury were more likely to require ICU admission (62.5 percent vs 24.7 percent; p=0.003), mechanical ventilation (43.5 percent vs 4.7 percent; p<0.001), and treatment with vasoactive agents (31.2 percent vs 0 percent; p<0.001).

High hs-TnT values were associated with greater disease severity (odds ratio, 6.63, 95 percent confidence interval, 2.24–19.65), and the three cases of deaths all occurred among patients with acute myocardial injury.

The findings underscore the need for targeted treatment and preventative strategies for this vulnerable patient group, according to the researchers.