ECG abnormalities, biomarker elevations among signs of cardiac involvement in COVID-19
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In a study of patients with COVID-19 who underwent cardiac MRI, among the signs of cardiac involvement in COVID-19 were cardiac symptoms, ECG abnormalities and cardiac biomarker elevations.
The researchers conducted a retrospective multicenter study of 1,047 patients with COVID-19 (mean age, 47 years; 48% women) confirmed by a polymerase chain reaction test who underwent cardiac MRI.
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Patients were categorized by whether they had myocardial injury, and if so, which of four types: acute myocarditis, nonacute nonischemic, acute ischemic or nonacute ischemic.
Among the cohort, 20.9% had a nonischemic myocardial injury pattern (acute myocarditis, 7.9%; nonacute nonischemic, 13%) and 6.7% had an ischemic myocardial injury pattern (acute ischemic, 1.9%; nonacute ischemic, 4.8%), Mahesh K. Vidula, MD, assistant professor of clinical medicine at the University of Pennsylvania, and colleagues wrote.
The researchers conducted analyses to determine variables associated with acute myocardial injury patterns.
In a univariate analysis, the following variables were associated with acute myocarditis patterns: chest discomfort (OR = 2; 95% CI, 1.17-3.4; P = .01), abnormal ECG findings (OR = 1.9; 95% CI, 1.12-3.23; P = .02), natriuretic peptide elevation (OR = 2.99; 95% CI, 1.6-5.58; P = .0006) and troponin elevation (OR = 4.21; 95% CI, 2.41-7.36; P < .0001).
The univariate analysis also determined the following variables were associated with acute ischemic patterns: chest discomfort (OR = 3.14; 95% CI, 1.04-9.49; P = .04), abnormal ECG findings (OR = 4.06; 95% CI: 1.1-14.92; P = .04), known coronary disease (OR = 33.3; 95% CI, 4.04-274.53; P = .001), hospitalization (OR = 4.98; 95% CI, 1.55-16.05; P = .007), natriuretic peptide elevation (OR = 4.19; 95% CI, 1.3-13.51; P = .02) and troponin elevation (OR = 25.27; 95% CI, 5.55-115.03; P < .0001).
In a multivariate analysis, troponin elevation remained strongly associated with acute myocarditis patterns (adjusted OR = 4.98; 95% CI, 1.76-14.05; P = .003), Vidula and colleagues wrote, noting that a multivariate analysis of factors associated with acute ischemic patterns was limited by missing data.
“We found that nonischemic and ischemic injury patterns are frequent in this patient cohort across various patient subgroups, and identified clinical variables associated with acute myocarditis and acute ischemic patterns,” Vidula and colleagues wrote. “These findings further our understanding of the characteristics and patterns of myocardial injury in patients diagnosed with COVID-19, and future studies are required to understand the prognostic significance of these findings.”
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