Abstract
Background Since December 2019, an emerging outbreak of novel coronavirus disease 2019 (COVID-19)
is caused by the severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2). The
aim of the present report is to describe a population with elevated levels of high-sensitive
cardiac troponin T (hs-cTnT) and report on their management during the pandemic of
COVID-19.
Methods In this retrospective cohort, we collected data from all patients with hs-cTnT levels
of >50 ng/mL admitted to Fribourg Hospital between February 15, 2020, and April 15,
2020. The primary diagnosis for troponin elevation was recorded. Echocardiographic,
electrocardiographic, and coronary angiographic data were analyzed for signs of myocardial
ischemia, infarction, or other cardiomyopathies. In-hospital follow-up was performed
for deaths from all causes and for cardiac deaths. Propensity score matching was used
in a subgroup analysis to match COVID-19 and non-COVID-19 patients (n = 21 per group).
Results Overall, 215 patients with high hs-cTnT levels were enrolled. The median age was
75 [65–83] years and 30% were women. 21 patients (10%) were diagnosed with COVID-19.
Of these, acute myocardial injury related to COVID-19 was the most commonly described
cardiovascular manifestation during the pandemic peak. Median troponin values were
not different between COVID-19 patients and non-COVID-19 patients (94 vs. 137, p = 0.14). The number of cardiological examinations was globally low (echocardiography
51% and coronary angiography 52%) in the context of the pandemic. Patients in the
COVID-19 group underwent significantly less echocardiographic examinations (19 vs.
55%, p ≤ 0.01) and coronary angiographies (5 vs. 58%, p ≤ 0.01) than non-COVID-19 patients. Overall mortality in patient with COVID-19 and
elevated troponins was very high, as 38% of patients died during hospitalization including
14% for cardiac death. This trend was confirmed in the propensity score–matched analysis.
Conclusion Interpretation of troponins during the COVID-19 pandemic was complicated due to the
low number of cardiovascular investigations in this context. Follow-up of patients
with COVID-19 and cardiovascular events is important to assess their prognosis and
to improve their care.
Keywords
COVID-19 - cardiovascular manifestation - troponin
