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Acute myocardial injury is common in patients with covid-19 and impairs their prognosis
  1. Jia-Fu Wei1,
  2. Fang-Yang Huang1,
  3. Tian-Yuan Xiong1,
  4. Qi Liu1,
  5. Hong Chen2,
  6. Hui Wang1,
  7. He Huang1,
  8. Yi-Chun Luo3,
  9. Xuan Zhou3,
  10. Zhi-Yue Liu1,
  11. Yong Peng1,
  12. Yuan-Ning Xu1,
  13. Bo Wang4,
  14. Ying-Ying Yang5,
  15. Zong-An Liang6,
  16. Xue-Zhong Lei7,
  17. Yang Ge8,
  18. Ming Yang9,
  19. Ling Zhang10,
  20. Ming-Quan Zeng10,
  21. He Yu7,
  22. Kai Liu7,
  23. Yu-Heng Jia1,
  24. Bernard D Prendergast11,
  25. Wei-Min Li6,
  26. Mao Chen1
  1. 1 Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
  2. 2 The Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
  3. 3 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
  4. 4 Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, China
  5. 5 Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
  6. 6 Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
  7. 7 Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
  8. 8 Department of Functional Examination Room, The Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
  9. 9 Department of Respiratory Medicine, The Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
  10. 10 Intensive Care Unit, The Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
  11. 11 Department of Cardiology, St Thomas’ Hospital, London, UK
  1. Correspondence to Professor Mao Chen, Department of Cardiology, Sichuan University West China Hospital, Chengdu 610041, China; hmaochen{at}vip.sina.com; Professor Wei-Min Li; weimi003{at}scu.edu.cn; Professor Bernard D Prendergast; bernard.prendergast{at}gstt.nhs.uk; Professor He Huang; huanghe{at}wchscu.cn

Abstract

Objective We sought to explore the prevalence and immediate clinical implications of acute myocardial injury in a cohort of patients with covid-19 in a region of China where medical resources are less stressed than in Wuhan (the epicentre of the pandemic).

Methods We prospectively assessed the medical records, laboratory results, chest CT images and use of medication in a cohort of patients presenting to two designated covid-19 treatment centres in Sichuan, China. Outcomes of interest included death, admission to an intensive care unit (ICU), need for mechanical ventilation, treatment with vasoactive agents and classification of disease severity. Acute myocardial injury was defined by a value of high-sensitivity troponin T (hs-TnT) greater than the normal upper limit.

Results A total of 101 cases were enrolled from January to 10 March 2020 (average age 49 years, IQR 34–62 years). Acute myocardial injury was present in 15.8% of patients, nearly half of whom had a hs-TnT value fivefold greater than the normal upper limit. Patients with acute myocardial injury were older, with a higher prevalence of pre-existing cardiovascular disease and more likely to require ICU admission (62.5% vs 24.7%, p=0.003), mechanical ventilation (43.5% vs 4.7%, p<0.001) and treatment with vasoactive agents (31.2% vs 0%, p<0.001). Log hs-TnT was associated with disease severity (OR 6.63, 95% CI 2.24 to 19.65), and all of the three deaths occurred in patients with acute myocardial injury.

Conclusion Acute myocardial injury is common in patients with covid-19 and is associated with adverse prognosis.

  • systemic inflammatory diseases
  • myocardial disease

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/heartjnl-2020-317007

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    Footnotes

    • J-FW, F-YH, T-YX, QL, HC and HW contributed equally.

    • Contributors Conception and design: MC, BDP, W-ML and HH. Data acquisition: YP, Y-NX, HC, Y-YY, BW, YG, M-QZ, MY, HY, KL, LZ and Y-HJ. Imaging process and analysis: LZ, Y-CL and XZ. Analysis of echocardiography: HW, HH and Z-YL. Analysis and interpretation of the data: J-FW, F-YH, QL and Y-CL. Drafting of the manuscript: J-FW, F-YH and T-YX. Critical revision for important intellectual content and final approval of the manuscript: all authors. Responsible for the overall content as the guarantors: MC and WML.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the institutional ethics committee (study number 2020–226) and all patients provided written informed consent

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data availability statement Data are available upon reasonable request. The datasets used during the current study are available from the corresponding author on reasonable request. Individual participant data without names and identifiers that underlie the result reported in this article are available on request. The data will be available for others to request immediately after publication of the article. The proposal with detailed description of study objectives will be needed for evaluation of the reasonability to request our data. The data requestors will need to sign a data access agreement to gain the datasets. The proposals should be directed to hmaochen@vip.sina.com.

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