tetano
Editor, Senior Moderator
J Am Coll Cardiol
. 2020 Jul 3;S0735-1097(20)35888-5.
doi: 10.1016/j.jacc.2020.06.068. Online ahead of print.
Cardiac Troponin for the Diagnosis and Risk-Stratification of Myocardial Injury in COVID-19: JACC Review Topic of the Week
Yader Sandoval[SUP] 1 [/SUP], James L Januzzi Jr[SUP] 2 [/SUP], Allan S Jaffe[SUP] 3 [/SUP]
Affiliations
Abstract
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.
Keywords: Cardiac troponin; Coronavirus disease 2019; Myocardial injury; Type 2 myocardial infarction.
. 2020 Jul 3;S0735-1097(20)35888-5.
doi: 10.1016/j.jacc.2020.06.068. Online ahead of print.
Cardiac Troponin for the Diagnosis and Risk-Stratification of Myocardial Injury in COVID-19: JACC Review Topic of the Week
Yader Sandoval[SUP] 1 [/SUP], James L Januzzi Jr[SUP] 2 [/SUP], Allan S Jaffe[SUP] 3 [/SUP]
Affiliations
- PMID: 32652195
- DOI: 10.1016/j.jacc.2020.06.068
Abstract
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.
Keywords: Cardiac troponin; Coronavirus disease 2019; Myocardial injury; Type 2 myocardial infarction.