key: cord-0739175-h84594h4
authors: Labbé, Vincent; Ederhy, Stephane; Lapidus, Nathanael; Salem, Joe-Elie; Trinh-Duc, Antoine; Cohen, Ariel; Fartoukh, Muriel; Voiriot, Guillaume
title: Characterization and outcomes of acute myocardial injury in COVID-19 intensive care patients
date: 2021-01-03
journal: Infection
DOI: 10.1007/s15010-020-01560-y
sha: d70d519276b8bb4bb78f46efc91b271275d1ca40
doc_id: 739175
cord_uid: h84594h4

nan

e Median (IQR) time from ICU admission: 0 (0-1) day; performed by trained operators with competence in advanced critical care TTE f Right ventricular severe dilatation: end-diastolic area ratio ≥ 1; paradoxical interventricular septum, n = 0 g Pericardial tamponade, n = 0 h Vv-ECMO, n = 5; Va-ECMO, n = 1 (in the acute myocardial injury group) i Patients fulfilled the following criteria: mean atrial pressure < 65 mm Hg without a vasopressor agent or need for vasopressor therapy to correct hypotension, low cardiac output, left ventricular systolic dysfunction without inotrope support; elevation of left heart pressures, at least one evidence of tissue hypo-perfusion j Ischaemic stroke, n = 3; non-cerebrovascular thromboembolism, n = 1 k Calculated as 28 minus the length of ICU stay , p = 0.02) than patients without MI. A greater proportion of patients with MI required catecholamine, invasive mechanical ventilation, and renal replacement therapy. Cardiovascular events occurred in 23 (25%) patients, including cardiac arrest (n = 1, 1.1%), cardiogenic shock (n = 4, 4.3%), arterial thrombotic event (n = 4, 4.3%), and death (n = 18; 19.6%). Figure 1 illustrates the association of mortality with MI (Kaplan-Meier survival curves, log-rank test p = 0.05). At day 28, the Odds Ratio (OR) for death and cardiovascular events in patients with versus without MI were 3.14 (95% CI 1.02-11.89) and 4.22 (95%CI 1.43-12.40) , respectively. When adjusting on sepsis-related organ failure assessment, these associations were not significant (OR 1.74, 95%CI 0.49-7.09 and OR 2.01, 95%CI 0.56-8.31, respectively). The magnitude of the Hs-cTnI initial values was associated with overall mortality (crude [OR] 2.42; 95%CI 1.25-4.94 per tenfold increase; Fig. 2 ). Median daily Hs-cTnI values during the first week of ICU admission remained higher in non-survivors, as compared with survivors (see Figure E1 in the online supplement data).

In this cohort of consecutive critically ill COVID-19 patients, the prevalence of MI was higher than that reported in non-ICU patients, suggesting that MI is related to an overall severity and a poor prognosis [1, 2] . Despite its association with an increased BNP level and a decreased left ventricular ejection fraction, MI rarely induced severe left ventricular systolic dysfunction. Severe right ventricular dilatation was also rarely diagnosed in our cohort, despite severe acute respiratory disease requiring mechanical ventilation. In line with our results, an international survey in COVID 19 patients reported left and right ventricular severe impairment in only 9% and 6% of cases [4] . As suggested by the absence of ECG abnormalities in most of our patients, MI may be mediated through non-ischemic mechanisms, such as cytokine storm or direct entry of SARS-CoV-2 into myocardial cells [5] . However, coronary mechanisms like microvascular damage, supply-demand inequity, or destabilization of atheroma cannot be excluded [2, 5] .

To summarize, acute myocardial injury is very frequent in critically ill COVID-19 patients and is associated with severity.

Author contributions VL, SE, MF, and GV contributed to study conception and design. VL, SE, GV, AT participated in acquiring the data. VL, AC, GV, SE, NL, and MF analyzed and interpreted the study data. VL drafted the original manuscript. All authors revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Funding No source of funding.

Availability of data and materials All data and materials are fully complying with field standards and might be available after request.

Conflict of interest AC received a research grant from Resicard; and consultant/advisory board fees from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Novartis, and Pfizer, unrelated with the present study. GV received research grant from Bio-Mérieux, SOS Oxygène, Janssen unrelated to the present study; and advisory board fees from BioMérieux unrelated to the present study. VL receives advisory board fees from Amomed unrelated with the present study. AT, JS, MF, NL, and SE declared no relevant conflict of interest.

The study has been approved by the local institutional ethical board (Sorbonne University, CER-2020-14) as a component of standard care and patient consent was waived, as per French Law.

Consent to participate Written and oral information was given to the patient or next of kin.

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