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Concomitant Myocardial Injury With COVID-19 Infection Linked to Fatal Outcome

Elevated TnT levels associated with arrhythmias, use of glucocorticoid therapy, mechanical ventilation

MONDAY, March 30, 2020 (HealthDay News) -- Myocardial injury is associated with fatal outcome in patients with coronavirus disease 2019 (COVID-19), according to research published online March 27 in JAMA Cardiology.

Tao Guo, M.D., from the Zhongnan Hospital of Wuhan University in China, and colleagues examined the correlation of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in a retrospective single-center case series involving 187 patients with confirmed COVID-19.

The researchers found that 35.3 percent of the patients had underlying CVD and 27.8 percent exhibited myocardial injury as indicated by elevated troponin T (TnT) levels. During hospitalization, mortality was 7.62, 13.33, 37.50, and 69.44 percent for those without underlying CVD and normal TnT levels, underlying CVD and normal TnT levels, without underlying CVD and with elevated TnT levels, and with underlying CVD and elevated TnT levels, respectively. There was a high and significantly positive linear correlation for plasma TnT levels with high-sensitivity C-reactive protein levels and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Significant increases in plasma TnT and NT-proBNP levels were seen during hospitalization and impending death versus admission values in patients who died but not in survivors. Patients with elevated TnT levels had more frequent malignant arrhythmias and higher use of glucocorticoid therapy and mechanical ventilation than those with normal TnT levels.

"Myocardial injury has a significant association with fatal outcomes of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury appears relatively favorable," the authors write.

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