Quantification of hs-Troponin Levels and Global Longitudinal Strain among Critical COVID-19 Patients with Myocardial Involvement

Mochamad Yusuf Alsagaff, Louisa Fadjri Kusuma Wardhani, Ricardo Adrian Nugraha, Tony Santoso Putra, Bagus Putra Dharma Khrisna, Makhyan Jibril Al-Farabi, Ruth Irena Gunadi, Yusuf Azmi, Christian Pramudita Budianto, Rosi Amrilla Fagi, Nadya Luthfah, Agus Subagjo, Yudi Her Oktaviono, Achmad Lefi, Budi Baktijasa Dharmadjati, Firas Farisi Alkaff, Budi Susetyo Pikir

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Myocardial involvement among critically ill patients with coronavirus disease 2019 (COVID-19) often has worse outcomes. An imbalance in the oxygen supply causes the excessive release of pro-inflammatory cytokines, which results in increased ventilation requirements and the risk of death in COVID-19 patients. Purpose. We evaluated the association between the hs-troponin I levels and global longitudinal strain (GLS) as evidence of myocardial involvement among critical COVID-19 patients. Methods. We conducted a prospective cohort study from 1 February to 31 July 2021 at RSUD Dr. Soetomo, Surabaya, as a COVID-19 referral center. Of the 65 critical COVID-19 patients included, 41 (63.1%) were men, with a median age (interquartile range) of 51.0 years (20.0–75.0). Subjects were recruited based on WHO criteria for severe COVID-19, and myocardial involvement in the form of myocarditis was assessed using CDC criteria. Subjects were examined using echocardiography to measure the GLS, and blood samples were taken to measure the hs-troponin. Subjects were then followed for their need for mechanical ventilation and in-hospital mortality. Results. Severe COVID-19 patients with cardiac injury were associated with an increased need for intubation (78.5%) and an increased incidence of myocarditis (50.8%). There was a relationship between the use of intubation and the risk of death in patients (66.7% vs. 33.3%, p-value < 0.001). Decreased GLS and increased hs-troponin were associated with increased myocarditis (p values < 0.001 and 0.004, respectively). Decreased GLS was associated with a higher need for mechanical ventilation (12.17 + 4.79 vs. 15.65 + 4.90, p-value = 0.02) and higher mortality (11.36 + 4.64 vs. 14.74 + 4.82; p-value = 0.005). Elevated hs-troponin was associated with a higher need for mechanical ventilation (25.33% vs. 3.56%, p-value = 0.002) and higher mortality (34.57% vs. 5.76%, p-value = 0.002). Conclusions. Critically ill COVID-19 patients with myocardial involvement and elevated cardiac troponin levels are associated with a higher need for mechanical ventilation and higher mortality.

Original languageEnglish
Article number352
JournalJournal of Clinical Medicine
Volume13
Issue number2
DOIs
Publication statusPublished - Jan 2024

Keywords

  • COVID-19
  • global longitudinal strain
  • hs-troponin
  • mechanical ventilation
  • mortality

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