The assessment of high sensitivity cardiac troponin in patients with COVID-19: a multicenter study

Alfonso Perrone, Marco; Spolaore, Federica; Ammirabile, Massimiliano; Romeo, Francesco; Caciagli, Patrizio; Ceriotti, Ferruccio; Bernardini, Sergio

Background Recent studies have shown that patients diagnosed with coronarivus disease 2019 (COVID-19) and also with previous cardiovascular diseases have a higher mortality due to worsening heart disease. At the same time, patients without previous cardiovascular disease may also have cardiac complications due to episodes of myocarditis. The aim of this multicenter study was to assess high sensitivity cardiac troponin T (hs-cTnT) in patients with COVID-19 and to evaluate the incidence of myocardial injury. Methods In this multicenter study we enrolled 543 patients, 57.8% males, median age 63 years (range 18-99) from three selected hospitals: University Hospital Tor Vergata in Rome, Fondazione IRCCS Ca 'Granda Ospedale Maggiore Policlinico, in Milan, S Chiara Hospital in Trento. We measured hs-cTnT in all patients to assess myocardial injury and correlations with patient’s age, symptoms and disease course. Results The data showed that, among the 543 patients studied, 257 patients (47.3%) had hs-cTnT values higher than the upper reference limit (URL) of 14 ng/L. Patients with high hs-cTnT had more frequently fever (p <0.01) and respiratory symptoms (p <0.01), compared to the group with hs-cTnT values below URL. The results showed also that patients with hs-cTnT above URL had a higher frequency of previous cardiovascular disease (p <0.01) as well as of hypertension (p<0.01). Instead, among 231 patients with no previous cardiovascular disease, 81 (31.5%) had hs-cTnT values above the URL. Finally. the majority of the patients with high hs-cTnT were admitted to the intensive care unit (p< 0.01). Conclusion To our knowledge this is the first multicenter study evaluating hs-cTnT in COVID-19 patients hospitalized in Italy. Our data recommend the dosage of cardiac troponin in COVID-19 patients for an early diagnosis of myocardial injury.