Increased Prevalence of Myocardial Injury in Patients with SARS-CoV-2 Viremia

Am J Med. 2021 Apr;134(4):542-546. doi: 10.1016/j.amjmed.2020.09.046. Epub 2020 Nov 10.

Abstract

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.

Keywords: COVID-19; Cardiac injury; Myocardial injury; SARS-CoV-2; Viral load.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • COVID-19* / blood
  • COVID-19* / epidemiology
  • COVID-19* / physiopathology
  • Cohort Studies
  • Female
  • Heart Diseases* / blood
  • Heart Diseases* / epidemiology
  • Heart Diseases* / virology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Myocardium / metabolism*
  • Prevalence
  • SARS-CoV-2 / isolation & purification*
  • Troponin / blood*
  • United States / epidemiology
  • Viral Load / methods
  • Viremia* / diagnosis
  • Viremia* / epidemiology
  • Viremia* / etiology

Substances

  • Troponin