SARS-CoV-2 病毒血症患者心肌损伤的患病率增加。
Increased Prevalence of Myocardial Injury in Patients with SARS-CoV-2 Viremia.
机构信息
Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
出版信息
Am J Med. 2021 Apr;134(4):542-546. doi: 10.1016/j.amjmed.2020.09.046. Epub 2020 Nov 10.
BACKGROUND
Patients with coronavirus disease 2019 (COVID-19) have a high prevalence of detectable troponin and myocardial injury. In addition, a subset of patients with COVID-19 has detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral loads. The objective of this study was to understand the relationship among SARS-CoV-2 viremia, detectable troponin, and myocardial injury in hospitalized patients with COVID-19.
METHODS
SARS-CoV-2 plasma viral load was measured in plasma samples drawn from patients hospitalized for COVID-19 at 2 academic medical centers. Baseline characteristics and clinically obtained high-sensitivity cardiac troponin T (hs-cTnT) values were abstracted from the medical record. The main outcome was detectable hs-cTnT (≥6 ng/mL) and myocardial injury (hs-cTnT ≥14 ng/mL; >99th percentile for assay).
RESULTS
A total of 70 hospitalized patients with COVID-19 were included in this study, with 39% females and median age 58 ± 17 years; 21 patients (30%) were found to have detectable SARS-CoV-2 viral load and were classified in the viremia group. Patients with viremia were significantly older than those without viremia. All of the patients with viremia (100%) had detectable troponin during hospitalization compared with 59% of patients without viremia (P = 0.0003). Myocardial injury was seen in 76% of patients with viremia and 38% of those patients without viremia (P = 0.004).
CONCLUSIONS
Hospitalized patients with COVID-19 with SARS-CoV-2 viremia have a significantly higher prevalence of detectable troponin and myocardial injury during their hospitalization compared with patients who did not. This first report of the relationship among SARS-CoV-2 viremia, detectable troponin, and myocardial injury in patients with COVID-19 points to additional mechanistic pathways that require deeper study to understand the complex interplay among these unique findings, cardiovascular outcomes, and mortality in COVID-19.
背景
患有 2019 年冠状病毒病（COVID-19）的患者肌钙蛋白升高和心肌损伤的发生率很高。此外，一部分 COVID-19 患者可检测到严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）病毒载量。本研究的目的是了解住院 COVID-19 患者中 SARS-CoV-2 血症、可检测到的肌钙蛋白和心肌损伤之间的关系。
方法
从在 2 所学术医疗中心住院治疗的 COVID-19 患者中抽取血浆样本，测量 SARS-CoV-2 血浆病毒载量。从病历中提取基线特征和临床获得的高敏心肌肌钙蛋白 T（hs-cTnT）值。主要结局是可检测到的 hs-cTnT（≥6ng/ml）和心肌损伤（hs-cTnT≥14ng/ml；检测方法的第 99 百分位以上）。
结果
本研究共纳入 70 例住院 COVID-19 患者，女性占 39%，中位年龄 58±17 岁；21 例（30%）患者检测到 SARS-CoV-2 病毒载量，归入病毒血症组。病毒血症患者明显比无病毒血症患者年龄更大。所有病毒血症患者（100%）在住院期间均可检测到肌钙蛋白，而无病毒血症患者中只有 59%（P=0.0003）可检测到肌钙蛋白。病毒血症患者的心肌损伤发生率为 76%，无病毒血症患者为 38%（P=0.004）。
结论
与无病毒血症患者相比，COVID-19 住院患者中 SARS-CoV-2 病毒血症患者在住院期间肌钙蛋白升高和心肌损伤的发生率明显更高。本研究首次报道 COVID-19 患者中 SARS-CoV-2 病毒血症、可检测肌钙蛋白和心肌损伤之间的关系，提示需要更深入地研究这些新发现之间的机制途径，以了解这些独特发现、心血管结局和 COVID-19 死亡率之间的复杂相互作用。
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