• Luca Arcari, Michelangelo Luciani, Luca Cacciotti, Maria Beatrice Musumeci, Valerio Spuntarelli, Eleonora Pistella, Dario Martolini, Daniele Manzo, Mariateresa Pucci, Claudio Marone, Serena Melandri, Gerardo Ansalone, Claudio Santini, Paolo Martelletti, Massimo Volpe, and Luciano De Biase.
• Department of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177, Rome, Italy. luca_arcari@outlook.it.
• Intern Emerg Med. 2020 Nov 1; 15 (8): 1467-1476.

BackgroundMyocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia.MethodsIn this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range.ResultsIncreased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B = - 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively).ConclusionsMyocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.

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