新冠肺炎住院患者中肌钙蛋白阳性与不良临床结局、超声心动图表现及死亡率之间的关联。

The association between troponin positivity and adverse clinical outcomes, echocardiographic findings, and mortality in hospitalized patients with COVID-19.

作者信息

Nabati Maryam, Abedini Mohammad Ali, Azizi Soheil, Moosazadeh Mahmood

机构信息

Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

出版信息

BMC Cardiovasc Disord. 2025 Sep 1;25(1):645. doi: 10.1186/s12872-025-05047-2.

DOI:10.1186/s12872-025-05047-2

PMID:40890571

Abstract

BACKGROUND

Troponin-I elevation during a COVID-19 infection is likely due to multiple factors. Few studies have investigated the relationship between troponin levels and echocardiographic variables in patients with COVID-19. Our study aimed to evaluate the clinical and paraclinical effects-including echocardiographic findings-of COVID-19 on myocardial injury, as indicated by elevated troponin levels, and to assess its potential impact on in-hospital and three-month outcomes in hospitalized COVID-19 patients.

METHODS

In this historical cohort study conducted at the Heart Hospital between 2021 and 2022, 161 hospitalized patients were included-72 with elevated troponin and 89 with normal troponin levels. Daily blood tests assessed complete blood count, electrolytes, blood sugar, CRP, blood urea nitrogen (BUN), and creatinine. All patients underwent transthoracic echocardiography within 24 h of admission to evaluate cardiac parameters, including left atrial and ventricular diameters, left ventricular (LV) ejection fraction, right ventricular (RV) size and function, and pulmonary artery pressure.

RESULTS

The troponin-positive group had a significantly higher prevalence of a history of cardiovascular disease compared to the troponin-negative group (65.3% vs. 40.4%, P = 0.01). Also, blood sugar, white blood cell count, BUN, and creatinine levels were significantly higher in the troponin-positive group (P = 0.035, 0.006, 0.006, and 0.006, respectively). Echocardiographic findings showed a significantly higher prevalence of left ventricular (LV) enlargement, LV systolic dysfunction, right ventricular (RV) systolic dysfunction, pulmonary hypertension, and significant mitral regurgitation in the troponin-positive group (P = 0.006 for all). Three- month mortality [9(23.1%) vs. 4(5.8%), P value = 0.048] was higher in in troponin-positive group than troponin negative group. Moreover, patients in troponin positive group had 6.6 times higher odds of death (OR = 6.64, 95% CI: 1.28-34.37, p = 0.024).

CONCLUSIONS

The results of our study suggest that elevated troponin levels in COVID-19 patients may serve as a marker of increased risk for more severe disease, significant left and right ventricular dysfunction, pulmonary hypertension, and higher mortality compared to those without elevated troponin levels.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

新型冠状病毒肺炎（COVID-19）感染期间肌钙蛋白I升高可能是多种因素所致。很少有研究调查COVID-19患者肌钙蛋白水平与超声心动图变量之间的关系。我们的研究旨在评估COVID-19对心肌损伤的临床和辅助检查影响，包括超声心动图结果，以肌钙蛋白水平升高为指标，并评估其对住院COVID-19患者住院期间及三个月预后的潜在影响。

方法

在2021年至2022年于心脏医院进行的这项历史性队列研究中，纳入了161例住院患者，其中72例肌钙蛋白升高，89例肌钙蛋白水平正常。每日血液检查评估全血细胞计数、电解质、血糖、CRP、血尿素氮（BUN）和肌酐。所有患者在入院后24小时内接受经胸超声心动图检查，以评估心脏参数，包括左心房和心室直径、左心室（LV）射血分数、右心室（RV）大小和功能以及肺动脉压。

结果

与肌钙蛋白阴性组相比，肌钙蛋白阳性组心血管疾病病史的患病率显著更高（65.3%对40.4%，P = 0.01）。此外，肌钙蛋白阳性组的血糖、白细胞计数、BUN和肌酐水平显著更高（分别为P = 0.035、0.006、0.006和0.006）。超声心动图结果显示，肌钙蛋白阳性组左心室（LV）扩大、LV收缩功能障碍、右心室（RV）收缩功能障碍、肺动脉高压和显著二尖瓣反流的患病率显著更高（所有P值均为0.006）。肌钙蛋白阳性组的三个月死亡率[9例（23.1%）对4例（5.8%），P值 = 0.048]高于肌钙蛋白阴性组。此外，肌钙蛋白阳性组患者死亡几率高6.6倍（OR = 6.64，95%CI：1.28 - 34.37，p = 0.024）。