Increased prevalence of myocardial injury in patients with SARS-CoV-2 viremia.

Siddiqi, Hasan K.; Weber, Brittany; Zhou, Guohai; Regan, James; Fajnzylber, Jesse; Coxen, Kendyll; Corry, Heather; Yu, Xu G.; DiCarli, Marcelo; Li, Jonathan Z.; Bhatt, Deepak L.

BACKGROUND: Patients with COVID-19 have a high prevalence of detectable troponin and myocardial injury. In addition, a subset of COVID-19 patients have detectable SARS-CoV-2 viral loads. The objective of this study is to understand the relationship between SARS-CoV-2 viremia, detectable troponin, and myocardial injury in hospitalized COVID-19 patients. METHODS: SARS-CoV-2 plasma viral load was measured in plasma samples drawn from patients hospitalized for COVID-19 at two academic medical centers. Baseline characteristics and clinically obtained high-sensitivity cardiac troponin T (hs-cTnT) values were abstracted from the medical record. The main outcome was detectable hs-cTnT (≥6ng/mL) and myocardial injury (hs-cTnT ≥14ng/mL; >99th percentile for assay). RESULTS: 70 hospitalized COVID-19 patients were included in this study, with 39% females and median age 58 +/- 17 years. 21 patients (30%) were found to have detectable SARS-CoV-2 viral load and were classified in the viremia group. Patients with viremia were significantly older than those without viremia. 100% of viremic patients had detectable troponin during hospitalization, compared to 59% of non-viremic patients (p=0.0003). Myocardial injury was seen in 76% of viremic patients and 38% of non-viremic patients (p=0.004). CONCLUSIONS: Hospitalized COVID-19 patients with SARS-CoV-2 viremia have a significantly higher prevalence of detectable troponin and myocardial injury during their hospitalization, compared to non-viremic patients. This first report of the relationship between SARS-CoV-2 viremia, detectable troponin and myocardial injury in COVID-19 patients points to additional mechanistic pathways that require deeper study to understand the complex interplay between these unique findings, cardiovascular outcomes and mortality in COVID-19.