Top

Published in:

01-11-2020 | Pneumonia | IM - ORIGINAL

Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

Authors: Luca Arcari, Michelangelo Luciani, Luca Cacciotti, Maria Beatrice Musumeci, Valerio Spuntarelli, Eleonora Pistella, Dario Martolini, Daniele Manzo, Mariateresa Pucci, Claudio Marone, Serena Melandri, Gerardo Ansalone, Claudio Santini, Paolo Martelletti, Massimo Volpe, Luciano De Biase

Published in: Internal and Emergency Medicine | Issue 8/2020

Abstract

Background

Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia.

Methods

In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range.

Results

Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and d-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and d-dimer (B = 0.419, p = 0.001; B = − 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively).

Conclusions

Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.

Available only for authorised users

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W (2020) A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 382:727–733. https://doi.org/10.1056/NEJMoa2001017CrossRef

Pennica A, Conforti G, Falangone F, Martocchia A, Tafaro L, Sentimentale A, Marini V, Pezzuto A, Spuntarelli V, Martelletti P (2020) Clinical management of adult coronavirus infection disease 2019 (COVID-19) positive in the setting of low and medium intensity of care: a short practical review. SN Compr Clin Med. https://doi.org/10.1007/s42399-020-00333-wCrossRef

Baraboutis IG, Gargalianos P, Aggelonidou E, Adraktas A (2020) Initial real-life experience from a designated COVID-19 centre in Athens, Greece: a proposed therapeutic algorithm. SN Compr Clin Med. https://doi.org/10.1007/s42399-020-00324-xCrossRef

Cogliati C, Ceriani E, Brambilla AM (2020) When internal and emergency medicine speak to each other: organization in the time of COVID. Intern Emerg Med 15:891–892CrossRef

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, Xing X, Xiang N, Wu Y, Li C, Chen Q, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TTY, Wu JT, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z (2020) Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 382:1199–1207. https://doi.org/10.1056/NEJMoa2001316CrossRef

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497–506. https://doi.org/10.1016/S0140-6736(20)30183-5CrossRef

Fogarty H, Townsend L, Ni Cheallaigh C, Bergin C, Martin-Loeches I, Browne P, Bacon CL, Gaule R, Gillett A, Byrne M, Ryan K, O’Connell N, O’Sullivan JM, Conlon N, O’Donnell JS (2020) COVID19 coagulopathy in Caucasian patients. Br J Haematol. https://doi.org/10.1111/bjh.16749CrossRef

Landi A, De Servi S (2020) The burden of thrombotic complications in critically ill patients with COVID-19: charting the uncharted. Intern Emerg Med 15:893–895CrossRef

Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, Zhang Z (2020) D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. https://doi.org/10.1111/jth.14859CrossRef

10.

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang X, Lu Z (2020) Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.1017CrossRef

11.

Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W, Liu X, Liang J, Zhao Q, Huang H, Yang B, Huang C (2020) Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.0950CrossRef

12.

Inciardi RM, Adamo M, Lupi L, Cani DS, Di Pasquale M, Tomasoni D, Italia L, Zaccone G, Tedino C, Fabbricatore D, Curnis A, Faggiano P, Gorga E, Lombardi CM, Milesi G, Vizzardi E, Volpini M, Nodari S, Specchia C, Maroldi R, Bezzi M, Metra M (2020) Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J. 41(19):1821–1829. https://doi.org/10.1093/eurheartj/ehaa388CrossRef

13.

Gao L, Jiang D, Wen XS, Cheng XC, Sun M, He B, You LN, Lei P, Tan XW, Qin S, Cai GQ, Zhang DY (2020) Prognostic value of NT-proBNP in patients with severe COVID-19. Respir Res. https://doi.org/10.1186/s12931-020-01352-wCrossRef

14.

Rath D, Petersen-Uribe Á, Avdiu A, Witzel K, Jaeger P, Zdanyte M, Heinzmann D, Tavlaki E, Müller K, Gawaz MP (2020) Impaired cardiac function is associated with mortality in patients with acute COVID-19 infection. Clin Res Cardiol. https://doi.org/10.1007/s00392-020-01683-0CrossRef

15.

Karbalai Saleh S, Oraii A, Soleimani A, Hadadi A, Shajari Z, Montazeri M, Moradi H, Talebpour M, Sadat Naseri A, Balali P, Akhbari M, Ashraf H (2020) The association between cardiac injury and outcomes in hospitalized patients with COVID-19. Intern Emerg Med. https://doi.org/10.1007/s11739-020-02466-1CrossRef

16.

Libby P (2020) The heart in COVID19: primary target or secondary bystander? JACC Basic to Transl Sci. https://doi.org/10.1016/j.jacbts.2020.04.001CrossRef

17.

Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D (2020) Elevated troponin in patients with Coronavirus Disease 2019 (COVID-19): possible mechanisms. J Card Fail. https://doi.org/10.1016/j.cardfail.2020.04.009CrossRef

18.

Tomasoni D, Italia L, Adamo M, Inciardi RM, Lombardi CM, Solomon SD, Metra M (2020) <scp>COVID</scp> 19 and heart failure: from infection to inflammation and angiotensin <scp>II</scp> stimulation. Searching for evidence from a new disease. Eur J Heart Fail. https://doi.org/10.1002/ejhf.1871CrossRef

19.

Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, Shchendrygina A, Escher F, Vasa-Nicotera M, Zeiher AM, Vehreschild M, Nagel E (2020) Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.3557CrossRef

20.

Skulstad H, Cosyns B, Popescu BA, Galderisi M, Di Salvo G, Donal E, Petersen S, Gimelli A, Haugaa KH, Muraru D, Almeida AG, Schulz-Menger J, Dweck MR, Pontone G, Sade LE, Gerber B, Maurovich-Horvat P, Bharucha T, Cameli M, Magne J, Westwood M, Maurer G, Edvardsen T (2020) COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel. Eur Heart J Cardiovasc Imaging. 21(6):592–598. https://doi.org/10.1093/ehjci/jeaa072CrossRef

21.

Favaloro E, Thachil J (2020) Reporting of D-dimer data in COVID-19: some confusion and potential for misinformation. Clin Chem Lab Med. https://doi.org/10.1515/CCLM-2020-0573CrossRef

22.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola V-P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129–2200. https://doi.org/10.1093/eurheartj/ehw128CrossRef

23.

Blackshear JL, Safford RE, Thomas CS, Bos JM, Ackerman MJ, Geske JB, Ommen SR, Shapiro BP, Johns GS (2018) Platelet function analyzer 100 and brain natriuretic peptide as biomarkers in obstructive hypertrophic cardiomyopathy. Am J Cardiol 121:768–774. https://doi.org/10.1016/j.amjcard.2017.12.009CrossRef

24.

Liu F, Li L, Da XuM, Wu J, Luo D, Zhu YS, Li BX, Song XY, Zhou X (2020) Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 127:104370. https://doi.org/10.1016/j.jcv.2020.104370CrossRef

25.

Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, Cheng Y, Yan J, Ping H, Zhou Q (2020) Suspected myocardial injury in patients with COVID-19: evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. https://doi.org/10.1016/j.ijcard.2020.03.087CrossRef

26.

https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_7-maggio-2020.pdf (last accessed on June 1^st 2020).

27.

Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y, Fu S, Gao L, Cheng Z, Lu Q, Hu Y, Luo G, Wang K, Lu Y, Li H, Wang S, Ruan S, Yang C, Mei C, Wang Y, Ding D, Wu F, Tang X, Ye X, Ye Y, Liu B, Yang J, Yin W, Wang A, Fan G, Zhou F, Liu Z, Gu X, Xu J, Shang L, Zhang Y, Cao L, Guo T, Wan Y, Qin H, Jiang Y, Jaki T, Hayden FG, Horby PW, Cao B, Wang C (2020) Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 395:1569–1578. https://doi.org/10.1016/S0140-6736(20)31022-9CrossRef

28.

Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533. https://doi.org/10.1001/jama.2012.5669CrossRef

29.

Christie DB, Nemec HM, Scott AM, Buchanan JT, Franklin CM, Ahmed A, Khan MS, Callender CW, James EA, Christie AB, Ashley DW (2020) Early outcomes with utilization of tissue plasminogen activator in COVID-19 associated respiratory distress: a series of five cases. J Trauma Acute Care Surg. https://doi.org/10.1097/TA.0000000000002787CrossRef

30.

Gattinoni L, Vassalli F, Romitti F (2018) Benefits and risks of the P/F approach. Intensive Care Med 44:2245–2247CrossRef

31.

Leonard-Lorant I, Delabranche X, Severac F, Helms J, Pauzet C, Collange O, Schneider F, Labani A, Bilbault P, Moliere S, Leyendecker P, Roy C, Ohana M (2020) Acute pulmonary embolism in COVID-19 patients on CT angiography and relationship to D-Dimer levels. Radiology. https://doi.org/10.1148/radiol.2020201561CrossRef

32.

Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M, Chen Y, Han Y (2020) Cardiovascular manifestations and treatment considerations in covid-19. Heart. https://doi.org/10.1136/heartjnl-2020-317056CrossRef

33.

Coccheri S (2020) COVID-19: the crucial role of blood coagulation and fibrinolysis. Intern Emerg Med. https://doi.org/10.1007/s11739-020-02443-8CrossRef

34.

Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H (2020) Endothelial cell infection and endotheliitis in COVID-19. Lancet 395:1417–1418CrossRef

35.

Boral BM, Williams DJ, Boral LI (2016) Disseminated intravascular coagulation. Am J Clin Pathol 146:670–680. https://doi.org/10.1093/ajcp/aqw195CrossRef

36.

Hendren NS, Drazner MH, Bozkurt B, Cooper LT Jr (2020) Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation. 141(23):1903–1914. https://doi.org/10.1161/CIRCULATIONAHA.120.047349CrossRef

37.

Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, Thursz M, Manousou P, Corbett R, Goldin R, Al-Sarraj S, Abdolrasouli A, Swann OC, Baillon L, Penn R, Barclay WS, Viola P, Osborn M (2020) Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe. https://doi.org/10.1016/S2666-5247(20)30115-4CrossRef

38.

Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, Feldt T, Green G, Green ML, Lescure F-X, Nicastri E, Oda R, Yo K, Quiros-Roldan E, Studemeister A, Redinski J, Ahmed S, Bernett J, Chelliah D, Chen D, Chihara S, Cohen SH, Cunningham J, D’Arminio Monforte A, Ismail S, Kato H, Lapadula G, L’Her E, Maeno T, Majumder S, Massari M, Mora-Rillo M, Mutoh Y, Nguyen D, Verweij E, Zoufaly A, Osinusi AO, DeZure A, Zhao Y, Zhong L, Chokkalingam A, Elboudwarej E, Telep L, Timbs L, Henne I, Sellers S, Cao H, Tan SK, Winterbourne L, Desai P, Mera R, Gaggar A, Myers RP, Brainard DM, Childs R, Flanigan T (2020) Compassionate use of Remdesivir for patients with severe Covid-19. N Engl J Med. https://doi.org/10.1056/nejmoa2007016CrossRef

39.

Panati K, Narala VR (2020) COVID-19 outbreak: an update on therapeutic options. SN Compr Clin Med 2:379–380. https://doi.org/10.1007/s42399-020-00264-6CrossRef

40.

Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, Camporota L (2020) COVID-19 pneumonia: different respiratory treatment for different phenotypes ? Intensive Care Med. https://doi.org/10.1007/s00134-020-06033-2CrossRef

41.

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z (2020) Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 18:1094–1099. https://doi.org/10.1111/jth.14817CrossRef

42.

Kim L, Garg S, O’Halloran A, Whitaker M, Pham H, Anderson EJ, Armistead I, Bennett NM, Billing L, Como-Sabetti K, Hill M, Kim S, Monroe ML, Muse A, Reingold AL, Schaffner W, Sutton M, Talbot HK, Torres SM, Yousey-Hindes K, Holstein R, Cummings C, Brammer L, Hall AJ, Fry AM, Langley GE (2020) Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the U.S. coronavirus disease 2019 (COVID-19)-associated hospitalization surveillance network (COVID-NET). Clin Infect Dis. https://doi.org/10.1093/cid/ciaa1012CrossRef

43.

Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, Gal Oz A, Rothschild E, Baruch G, Peri Y, Arbel Y, Topilsky Y (2020) The spectrum of cardiac manifestations in coronavirus disease 2019 (COVID-19)—a systematic echocardiographic study. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.120.047971CrossRef

Title: Incidence and determinants of high-sensitivity troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients
Authors: Luca Arcari
Michelangelo Luciani
Luca Cacciotti
Maria Beatrice Musumeci
Valerio Spuntarelli
Eleonora Pistella
Dario Martolini
Daniele Manzo
Mariateresa Pucci
Claudio Marone
Serena Melandri
Gerardo Ansalone
Claudio Santini
Paolo Martelletti
Massimo Volpe
Luciano De Biase
Publication date: 01-11-2020
Publisher: Springer International Publishing
Keywords: Pneumonia
COVID-19
Biomarkers
Published in: Internal and Emergency Medicine / Issue 8/2020
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-020-02498-7

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2020

Decline in emergency medical service missions during the COVID-19 pandemic: results from the fifth largest city in Germany

Current treatment of COVID-19 in renal patients: hope or hype?

The association of treatment with hydroxychloroquine and hospital mortality in COVID-19 patients

COVID-19: in the uncertainty, do not try this at home

The SARS-CoV-2 receptor, ACE-2, is expressed on many different cell types: implications for ACE-inhibitor- and angiotensin II receptor blocker-based antihypertensive therapies—reply

Camostat mesilate therapy for COVID-19

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage