Heart Injury Among Hospitalized COVID-19 Patients Associated With Higher Risk of Death

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Myocardial injury (heart muscle damage) is common among patients hospitalized with COVID-19 and is associated with a higher risk of mortality, finds a new study. A serious myocardial injury can triple the risk of death. Results were published in the Journal of the American College of Cardiology.

“We found that 36 percent of patients who were hospitalized with COVID-19 had elevated troponin levels – which represents heart injury – and were at higher risk of death,” said lead author Anu Lala, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai. These findings are consistent with reports from China and Europe.

Troponins are proteins that are released when the heart muscle becomes damaged and higher troponin levels mean greater heart damage. 

Investigators analyzed electronic health records of nearly 3,000 adult patients with confirmed positive COVID-19 admitted to five New York City hospitals within the Mount Sinai Health System between February 27 and April 12, 2020. The median age for patients analyzed was 66, and roughly 60 percent were male. Roughly 25 percent of the patients had a history of heart disease (including coronary artery disease, atrial fibrillation, and heart failure) and roughly 25 percent had cardiovascular disease risk factors (including diabetes or hypertension).

Results showed that 36 percent of hospitalized COVID-19 patients had a myocardial injury. For those with substantial injury, their risk of death was three times higher than COVID-19-positive patients without myocardial injury.

All patients had a blood test for this within 24 hours of admission and were grouped into three categories: 64 percent were in the normal range (0.00-0.03 ng/mL); 17 percent had mild elevation (between one and three times the upper limit of normal, or >0.03-0.09 ng/mL), and 19 percent had higher elevation (more than three times the upper limit of normal, or >0.09 ng/mL). Higher troponin levels were more prevalent in patients who were over 70 years old and had previously known conditions including diabetes, high blood pressure, atrial fibrillation, coronary artery disease, and heart failure. 

After adjusting for factors including age, sex, body mass index, history of cardiovascular disease, medication, and illness at hospital admission, researchers found that patients with milder forms of myocardial injury were associated with a lower likelihood of hospital discharge and a 75 percent higher risk of death compared to patients with normal levels. Patients with higher troponin concentrations were associated with three times higher risk of death compared to those with normal levels. Additionally, when adjusting for relevant factors including heart disease, diabetes, and high blood pressure, troponin was independently associated with the risk of death. 

“The study concludes that myocardial injury is common among patients hospitalized with COVID -19 but is more often mild and associated with low-level troponin elevation. Despite low levels, even small amounts of heart injury could be linked to a pronounced risk of death, and COVID-19 patients with a history of cardiovascular disease are more likely to have a myocardial injury when compared to patients without heart disease,” explained Dr. Lala.

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