Characterization of Myocardial Injury in Patients With COVID-19.
Characterization of Myocardial Injury in Patients With COVID-19.
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DOI：
10.1016/j.jacc.2020.08.069
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发表时间：
2020-11-03
影响因子：
24
通讯作者：
Goldman ME
中科院分区：
文献类型：
--
作者：
Giustino G;Croft LB;Stefanini GG;Bragato R;Silbiger JJ;Vicenzi M;Danilov T;Kukar N;Shaban N;Kini A;Camaj A;Bienstock SW;Rashed ER;Rahman K;Oates CP;Buckley S;Elbaum LS;Arkonac D;Fiter R;Singh R;Li E;Razuk V;Robinson SE;Miller M;Bier B;Donghi V;Pisaniello M;Mantovani R;Pinto G;Rota I;Baggio S;Chiarito M;Fazzari F;Cusmano I;Curzi M;Ro R;Malick W;Kamran M;Kohli-Seth R;Bassily-Marcus AM;Neibart E;Serrao G;Perk G;Mancini D;Reddy VY;Pinney SP;Dangas G;Blasi F;Sharma SK;Mehran R;Condorelli G;Stone GW;Fuster V;Lerakis S;Goldman ME
心肌损伤在2019冠状病毒病（COVID-19）住院患者中很常见，并与预后不良相关。然而，心肌损伤的机制尚不清楚，先前的研究尚未报道心血管影像学数据。本研究旨在描述COVID-19患者与心肌损伤相关的超声心动图异常及其对预后的影响。我们开展了一项国际多中心队列研究，包括纽约和米兰的7家医院，对实验室确诊的COVID-19住院患者进行了经胸超声心动图（TTE）和心电图评估。心肌损伤定义为临床表现或住院期间心肌肌钙蛋白升高。共纳入305例患者。平均年龄63岁，男性205例（67.2%）。总体而言，心肌损伤190例（62.3%）。与无心肌损伤的患者相比，心肌损伤的患者有更多的心电图异常，更高的炎症生物标志物和主要超声心动图异常的患病率增加，包括左室壁运动异常，整体左室功能障碍，左室舒张功能II级或III级功能障碍，右室功能障碍和心包积液。无心肌损伤、心肌损伤伴TTE异常、心肌损伤伴TTE异常患者的住院死亡率分别为5.2%、18.6%和31.7%。多变量校正后，伴有TTE异常的心肌损伤与较高的死亡风险相关，而不伴有TTE异常的心肌损伤与较高的死亡风险相关。在接受TTE治疗的COVID-19患者中，近三分之二的心肌损伤患者存在心脏结构异常。心肌损伤与住院死亡率增加相关，特别是超声心动图异常时。
Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.
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