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This JACC Review Topic of the Week evaluates the role of cardiac troponin in patients with COVID-19. Increases in cardiac troponin are more likely to occur in those with severe COVID-19 or in those with chronic cardiovascular conditions. With COVID-19, elevated cardiac troponin can occur due to cardiac or noncardiac causes. Cardiac causes include myocarditis, acute heart failure, stress cardiomyopathy, and direct viral injury. Noncardiac causes included pulmonary embolism, sepsis, and critical illness.
Serial cardiac troponins can aid with risk stratification and clinical management in COVID-19.
This abstract is available on the publisher's site.
Increases in cardiac troponin indicative of myocardial injury are common in patients with coronavirus disease-2019 (COVID-19) and are associated with adverse outcomes such as arrhythmias and death. These increases are more likely to occur in those with chronic cardiovascular conditions and in those with severe COVID-19 presentations. The increased inflammatory, prothrombotic, and procoagulant responses following severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection increase the risk for acute nonischemic myocardial injury and acute myocardial infarction, particularly type 2 myocardial infarction, because of respiratory failure with hypoxia and hemodynamic instability in critically ill patients. Myocarditis, stress cardiomyopathy, acute heart failure, and direct injury from SARS-CoV-2 are important etiologies, but primary noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis, probably cause more of the myocardial injury. The structured use of serial cardiac troponin has the potential to facilitate risk stratification, help make decisions about when to use imaging, and inform stage categorization and disease phenotyping among hospitalized COVID-19 patients.