Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy.
Covid Unit 2, Madre Giuseppina Vannini Hospital, Rome, Italy.
Intern Emerg Med. 2020 Nov;15(8):1467-1476. doi: 10.1007/s11739-020-02498-7. Epub 2020 Sep 28.
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.
In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range.
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).
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.
已有报道称，在 2019 年冠状病毒病（COVID-19）肺炎的病程中存在心肌受累，但尚未对其进行充分描述。本研究旨在联合评估因 COVID-19 肺炎住院的患者的高敏肌钙蛋白（hs-Troponin）和利钠肽（NP）。
在这项多中心观察性研究中，我们分析了 n=111 例患者的数据。根据超出参考范围的值确定心脏生物标志物亚组。
分别有 38%和 56%的患者 hs-Troponin 和 NP 升高。与心脏生物标志物正常的患者相比，这些患者年龄较大，心血管疾病（CVD）患病率较高，C 反应蛋白和 D-二聚体较高，动脉血氧分压/吸入氧分数（PaO2/FIO2）较低，COVID-19 肺炎更严重。对部分患者（n=24）进行二维超声心动图检查，发现 NP 升高的患者左心室射血分数显著降低（p=0.02），而 hs-Troponin 和 NP 升高的患者右心室收缩功能（三尖瓣环平面收缩位移）均显著降低（p=0.022 和 p=0.03，分别）。hs-Troponin 和 NP 升高的患者住院死亡率均较高（p=0.001 和 p=0.002，分别）。多变量分析显示，hs-Troponin 与年龄、PaO2/FIO2 和 D-二聚体独立相关（B=0.419，p=0.001；B=-0.212，p=0.013；B=0.179，p=0.037，分别），NP 与年龄和既往 CVD 独立相关（B=0.480，p<0.001；B=0.253，p=0.001，分别）。
COVID-19 肺炎患者入院时心肌受累常见。hs-Troponin 与疾病严重程度标志物相关，NP 与基础 CVD 相关，这可能表明在这种情况下，它们升高的机制不同。
