scholarly journals Prevalence and Prognostic Value of Myocardial Injury in the Initial Presentation of SARS-CoV-2 Infection among Older Adults

2021 ◽  
Vol 10 (16) ◽  
pp. 3738
Author(s):  
Isabel Arnau-Barrés ◽  
Ana Pascual-Dapena ◽  
Inmaculada López-Montesinos ◽  
Silvia Gómez-Zorrilla ◽  
Luisa Sorlí ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Mortality ◽  
Myocardial Injury ◽  
Adult Group ◽  
Reference Limit ◽  
Acute Myocardial Injury ◽  
Comorbidity Index ◽  
Myocardial Involvement ◽  
Upper Reference Limit ◽  
High Sensitive Troponin

Myocardial involvement during SARS-CoV-2 infection has been reported in many prior publications. We aim to study the prevalence and the clinical implications of acute myocardial injury (MIN) during SARS-CoV-2 infection, particularly in older patients. The method includes a longitudinal observational study with all consecutive adult patients admitted to a COVID-19 unit between March–April 2020. Those aged ≥65 were considered as older adult group. MIN was defined as at least 1 high-sensitive troponin (hs-TnT) concentration above the 99th percentile upper reference limit with different sex-cutoff. Results. Among the 634 patients admitted during the period of observation, 365 (58%) had evidence of MIN, and, of them, 224 (61%) were older adults. Among older adults, MIN was associated with longer time to recovery compared to those without MIN (13 days (IQR 6-21) versus 9 days (IQR 5-17); p < 0.001, respectively. In-hospital mortality was significantly higher in older adults with MIN at admission versus those without it (71 (31%) versus 11 (12%); p < 0.001). In a logistic regression model adjusting by age, sex, severity, and Charlson Comorbidity Index, the OR for in-hospital mortality was 2.1 (95% CI: 1.02–4.42; p = 0.043) among those older adults with MIN at admission. Older adults with acute myocardial injury had greater time to clinical recovery, as well as higher odds of in-hospital mortality.

scholarly journals Prevalence and Prognostic Value of Myocardial Injury in the Initial Presentation of SARS-CoV-2 Infection among Older Adults

2021 ◽  
Author(s):  
Isabel Arnau-Barres ◽  
Ana Pascual-Dapena ◽  
Inmaculada López-Montesinos ◽  
Silvia Gómez-Zorrilla ◽  
Luisa Sorli ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Mortality ◽  
Myocardial Injury ◽  
Functional Decline ◽  
Clinical Prognosis ◽  
Reference Limit ◽  
Inflammatory Parameters ◽  
Acute Myocardial Injury ◽  
Comorbidity Index ◽  
Upper Reference Limit

Abstract Myocardial involvement during SARS-CoV-2 infection has been reported in many prior publications. Data about this condition in older adults is scarce especially its role in clinical prognosis. We aim to study the prevalence and the clinical implications of acute myocardial injury (MIN) during SARS-CoV-2 infection, particularly in older patients.MethodsLongitudinal observational study where all consecutive adult patients admitted to a COVID-19 unit between March to April 2020 were included. Those patients aged ≥65 were considered as older patients. MIN was defined as at least 1 high-sensitive troponin (hs-TnT) concentration above the 99th percentile upper reference limit with different sex-cutoff.ResultsAmong the 634 patients admitted during the period of observation 365(58%) had evidence of MIN (hs-TnT>14 pg/mL), and among those 224(61%) were older adults. Individuals with acute MIN were more prone to be older, had more comorbidities, more functional decline at admission, and higher inflammatory parameters. Among older adults, MIN was associated with longer time to recovery compared to those without MIN [13 days(IQR 6-21) vs 9 days(IQR 5-17);p<0.001 repectively. In-hospital mortality was significantly higher in older adults with MIN at admission vs those without MIN [71(31%) vs 11(12%);p<0.001]. In a logistic regression model adjusting by age, sex, severity and Charlson comorbidity index the OR for in-hospital mortality was 2.1 (95% CI:1.02-4.42;p=0.043) among those older adults with MIN at presentation.ConclusionMIN is frequent in individuals with SARS-CoV-2 infection, especially in older adults and in patients with pre-existing comorbidities and with higher inflammatory levels. Older adults with acute myocardial injury had greater time to clinical recovery, more severe presentation of the disease and higher odds of in-hospital mortality.

Abstract 14870: Clinical Significance of Troponin Elevation in a Contemporary Hospitalized Population: Endotypes, Morbidity and In-hospital Mortality

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Briscoe ◽  
Robert A Sykes ◽  
Thomas Krysztofiak ◽  
Kenneth Mangion ◽  
Oliver H Peck ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Myocardial Injury ◽  
Troponin I ◽  
Coronary Revascularization ◽  
High Sensitivity ◽  
Hospitalized Patients ◽  
Troponin Elevation ◽  
Reference Limit ◽  
Upper Reference Limit

Introduction: Unplanned hospitalizations are commonly associated with a circulating troponin concentration >99 th percentile upper reference limit (URL). In order to better understand the clinical significance of troponin elevation, we evaluated outcomes in hospitalized patients according to cardiac endotype. Methods: We prospectively screened consecutive hospitalized patients with elevated high-sensitivity troponin-I (hs-TnI) concentrations (Abbott ARCHITECT troponin-I assay; sex-specific URL, 99 th centile: male: >34ng/L; female: >16ng/L) within a regional cardiac care network (population 650,000). A cardiology clinical team adjudicated individual patient records and assigned endotypes by consensus agreement according to the Fourth Universal Definition of Myocardial Infarction (MI). Endotypes were sub-classified into etiological category by inciting event(s). Characteristics and comorbidity were compared and outcomes recorded on virtual follow-up until June 2 nd 2020. Results: A total of 390 consecutive patients with ≥1 hs-TnI value >URL between March 1-April 15, 2020, were evaluated; 44 patients were excluded ( Duplicates: 2; Missing data: 41; Research patient: 1 ). Of 346 who qualified for inclusion, an index diagnosis of Type 1 MI (T1MI), T2MI and myocardial injury were assigned in 115 (33.2%), 79 (22.8%) and 152 (43.9%) patients, respectively. Compared with T1MI, patients with T2MI and myocardial injury had lower peak hs-TnI values (median [IQR]: 86 [250-697] vs 5020 [853-7774]ng/L; p< 0.01), lower estimated 10-year survival (40.2% vs 53.4%; p=0.002), less frequently underwent coronary revascularization (1.4% vs 45.2%; p<0.0005) and had longer inpatient stay (13.0 vs 6.1 days). Inpatient and overall mortality rates from admission to follow-up (median [range]: 71 [0-151] days) were higher among patients with T2MI and myocardial injury (19.9% vs 7.8%; p=0.004; and 26.0% vs 11.3%; Log rank (Mantel-Cox) X 2 = 1.927; p=0.003) independent of similar cardiovascular risk profiles. Conclusions: Despite lower peak circulating troponin concentrations, patients with T2MI and myocardial injury had higher inpatient mortality, lower estimated 10-year survival and longer in-hospital stay compared to those with T1MI.

scholarly journals Improved detection of minor ischemic myocardial injury with measurement of serum cardiac troponin I

1997 ◽  
Vol 43 (11) ◽  
pp. 2047-2051 ◽  
Author(s):  
Fred S Apple ◽  
Alireza Falahati ◽  
Pamela R Paulsen ◽  
Elizabeth A Miller ◽  
Scott W Sharkey
Keyword(s):  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Clinical Sensitivity ◽  
Reference Limit ◽  
Normal Limits ◽  
Serial Serum ◽  
Upper Reference Limit ◽  
Serum Cardiac Troponin

Abstract This study compared the diagnostic accuracy of the measurement of serum cardiac troponin I (cTnI) with creatine kinase (CK) MB mass in patients with minor myocardial injury whose measured total CK activity did not exceed twice the upper reference limit (300 U/L for men; 200 U/L for women). Forty-eight consecutive patients presenting with chest pain and with in-hospital documentation of myocardial injury were enrolled. Electrocardiogram, echocardiogram, and serial serum CK-MB mass, cTnI, and total CK were measured over 36 h after admission. Peak total CK activity was within normal limits in 28 patients (58%). The mean (±SD) peak CK-MB mass and cTnI concentrations were: 16.4 (11.8) μg/L and 132 (13.0) μg/L; respectively. The peak biochemical marker index (defined as CK-MB or cTnI divided by its respective upper reference limit) was significantly (P &lt;0.05) higher for cTnI than for CK-MB from 7 to 36 h. The clinical sensitivity for detection of myocardial injury for cTnI was 100% [95% confidence interval (CI): 87.2% to 100%], compared with 81.8% (CI: 67.3% to 91.8%) for CK-MB. Thus, cTnI was more sensitive than CK-MB mass for detection of myocardial injury in patients with small increases of total CK.

scholarly journals Effects of short-term bisoprolol on perioperative myocardial injury in patients undergoing non-cardiac surgery: a randomized control study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wanwarang Wongcharoen ◽  
Thanyalak Chotayaporn ◽  
Kavint Chutikhongchalermroj ◽  
Apichat Tantraworasin ◽  
Somcharoen Saeteng ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Beta Blocker ◽  
Myocardial Injury ◽  
Troponin T ◽  
Protective Role ◽  
Reference Limit ◽  
Intraoperative Hypotension ◽  
Significant Difference ◽  
Upper Reference Limit

AbstractThe protective role of preoperative beta-blocker in patients undergoing non-cardiac surgery is unknown. We aimed to evaluate the effects of beta-blocker on perioperative myocardial injury in patients undergoing non-cardiac surgery. We consecutively enrolled 112 patients undergoing non-cardiac surgery. They were randomly allocated to receive bisoprolol or placebo given at least 2 days preoperatively and continued until 30 days after surgery. The primary outcome was incidence of perioperative myocardial injury defined by a rise of high-sensitive troponin-T (hs-TnT) more than 99th percentile of upper reference limit or a rise of hs-TnT more than 20% if baseline level is abnormal. Baseline characteristics were comparable between bisoprolol and placebo in randomized cohort Mean age was 62.5 ± 11.8 years and 76 (67.8%) of 112 patients were male. Among 112 patients, 49 (43.8%) underwent vascular surgery and 63 (56.2%) underwent thoracic surgery. The median duration of assigned treatment prior to surgery was 4 days (2–6 days). We did not demonstrate the significant difference in the incidence of perioperative myocardial injury [52.6% (30 of 57 patients) vs. 49.1% (27 of 55 patients), P = 0.706]. In addition, the incidence of intraoperative hypotension was higher in bisoprolol group than placebo group in patients undergoing non-cardiac surgery [70.2% (40 of 57 patients) vs. 47.3% (26 of 55 patients), P = 0.017]. We demonstrated that there was no statistically significant difference in perioperative myocardial injury observed between patients receiving bisoprolol and placebo who had undergone non-cardiac surgery.

scholarly journals Colchicine to Prevent Periprocedural Myocardial Injury in Percutaneous Coronary Intervention: The COPE-PCI Pilot Trial

2021 ◽  
Vol 14 (5) ◽  
Author(s):  
Justin Cole ◽  
Nay Htun ◽  
Robert Lew ◽  
Mark Freilich ◽  
Stephen Quinn ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Troponin I ◽  
Pilot Trial ◽  
Supporting Evidence ◽  
St Segment Elevation ◽  
Reference Limit ◽  
Periprocedural Myocardial Infarction ◽  
Upper Reference Limit ◽  
Periprocedural Myocardial Injury

Background: Periprocedural myocardial infarction and injury (PM-injury) are the most common complications of percutaneous coronary intervention (PCI) and are associated with future adverse cardiac events. Inflammation plays a pivotal role in the development of PM-injury. In this randomized pilot trial, we assessed the effect of an anti-inflammatory medication colchicine on periprocedural myocardial injury. Methods: Patients undergoing PCI for stable angina or non–ST-segment–elevation myocardial infarction were randomized to oral colchicine (1 mg followed by 0.5 mg 1 hour later) or placebo, 6 to 24 hours preprocedure. Blood samples were taken immediately pre- and 24-hours post-PCI. The primary outcome, periprocedural myocardial infarction, was defined by an increase in post-PCI troponin >5×99th% upper reference limit when the pre-PCI troponin was normal, or >20% increase in post-PCI troponin when the pre-PCI troponin was raised, including supporting evidence of new myocardial ischemia. Major PM-injury was defined as per periprocedural myocardial infarction without supporting evidence of new myocardial ischemia. Minor PM-injury was defined by post-PCI troponin increase >99th% upper reference limit but ≤5×99th% upper reference limit. Results: A total of 196 patients met inclusion criteria and were randomized. One hundred twenty-one patients were excluded (no PCI, unstable troponin before PCI, or poor-quality measurements) leaving a study population of 75 patients. Thirty-six patients were randomized to colchicine and 39 to placebo preprocedure. Forty-four presented with non–ST-segment–elevation myocardial infarction and 31 with stable angina. High-sensitive (hs) troponin-I pre-PCI was similar between treatment groups (colchicine: 79 ng/L [4–1336] versus placebo: 35 [5–448], P =0.42). Absolute change in hs-troponin-I (calculated as 24-hour post-PCI minus pre-PCI measurements) was significantly lower in the colchicine group: 59 (1–221) versus placebo: 166 (53–530), P =0.02. No patients developed periprocedural myocardial infarction in either group. Significantly fewer patients developed major PM-injury: 11 (31%) versus 21 (54%), P =0.04 or minor PM-injury: 21 (58%) versus 33 (85%), P =0.01, if given colchicine pre-PCI. Conclusions: In this randomized pilot trial, colchicine given 6 to 24 hours pre-PCI reduces periprocedural myocardial injury. Registration: URL: https://www.anzctr.org.au ; Unique identifier: ACTRN12615000485538.

scholarly journals COVID-19 and its impact on the cardiovascular system

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001472 ◽  
Author(s):  
Saud Ahmed Khawaja ◽  
Poornima Mohan ◽  
Richard Jabbour ◽  
Theodora Bampouri ◽  
Gemma Bowsher ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Myocardial Injury ◽  
Invasive Coronary Angiography ◽  
Pacemaker Implantation ◽  
Coronary Intervention ◽  
Cardiovascular Complications ◽  
Hospital Outcomes ◽  
Number Of Patients ◽  
Acute Myocardial Injury ◽  
Initial Cohort

ObjectivesThe clinical impact of SARS-CoV-2 has varied across countries with varying cardiovascular manifestations. We review the cardiac presentations, in-hospital outcomes and development of cardiovascular complications in the initial cohort of SARS-CoV-2 positive patients at Imperial College Healthcare National Health Service Trust, UK.MethodsWe retrospectively analysed 498 COVID-19 positive adult admissions to our institute from 7 March to 7 April 2020. Patient data were collected for baseline demographics, comorbidities and in-hospital outcomes, especially relating to cardiovascular intervention.ResultsMean age was 67.4±16.1 years and 62.2% (n=310) were male. 64.1% (n=319) of our cohort had underlying cardiovascular disease (CVD) with 53.4% (n=266) having hypertension. 43.2%(n=215) developed acute myocardial injury. Mortality was significantly increased in those patients with myocardial injury (47.4% vs 18.4%, p<0.001). Only four COVID-19 patients had invasive coronary angiography, two underwent percutaneous coronary intervention and one required a permanent pacemaker implantation. 7.0% (n=35) of patients had an inpatient echocardiogram. Acute myocardial injury (OR 2.39, 95% CI 1.31 to 4.40, p=0.005) and history of hypertension (OR 1.88, 95% CI 1.01 to 3.55, p=0.049) approximately doubled the odds of in-hospital mortality in patients admitted with COVID-19 after other variables had been controlled for.ConclusionHypertension, pre-existing CVD and acute myocardial injury were associated with increased in-hospital mortality in our cohort of COVID-19 patients. However, only a low number of patients required invasive cardiac intervention.

European multicenter analytical evaluation of the Abbott ARCHITECT STAT high sensitive troponin I immunoassay

2014 ◽  
Vol 0 (0) ◽  
Author(s):  
Magdalena Krintus ◽  
Marek Kozinski ◽  
Pascal Boudry ◽  
Nuria Estañ Capell ◽  
Ursula Köller ◽  
...  
Keyword(s):  
Troponin I ◽  
Healthy Population ◽  
Sample Type ◽  
Reference Limit ◽  
Upper Reference Limit ◽  
Analytical Requirements ◽  
Sample Dilution ◽  
Abbott Architect ◽  
High Sensitive Troponin ◽  
Apparently Healthy

AbstractInternational recommendations highlight the superior value of cardiac troponins (cTns) for early diagnosis of myocardial infarction along with analytical requirements of improved precision and detectability. In this multicenter study, we investigated the analytical performance of a new high sensitive cardiac troponin I (hs-cTnI) assay and its 99th percentile upper reference limit (URL).Laboratories from nine European countries evaluated the ARCHITECTTotal imprecision of 3.3%–8.9%, 2.0%–3.5% and 1.5%–5.2% was determined for the low, medium and high controls, respectively. The lowest cTnI concentration corresponding to a total CV of 10% was 5.6 ng/L. Common interferences, sample dilution and carryover did not affect the hs-cTnI results. Slight, but statistically significant, differences with sample type were found. Concordance between the investigated hs-cTnI assay and contemporary cTnI assay at 99th percentile cut-off was found to be 95%. TnI was detectable in 75% and 57% of the apparently healthy population using the lower (1.1 ng/L) and upper (1.9 ng/L) limit of the LoD range provided by the ARCHITECTThe new ARCHITECT

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