Cardiovascular biomarkers in patients with COVID-19

Author:

Mueller Christian1ORCID,Giannitsis Evangelos2,Jaffe Allan S3,Huber Kurt4ORCID,Mair Johannes5ORCID,Cullen Louise6ORCID,Hammarsten Ola7,Mills Nicholas L8ORCID,Möckel Martin9,Krychtiuk Konstantin10ORCID,Thygesen Kristian11ORCID,Lindahl Bertil12ORCID,

Affiliation:

1. Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland

2. Department of Cardiology, University Heidelberg, Heidelberg, Germany

3. Mayo Clinic and Medical School, Rochester, MN, USA

4. Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, and Sigmund Freud University, Medical School, Vienna, Austria

5. Department of Internal Medicine III—Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria

6. Emergency and Trauma Centre, Royal Brisbane and Women`s Hospital, University of Queensland, St Lucia, QLD, Australia

7. Department of Clinical Chemistry and Transfusion Medicine, University of Gothenburg, Gothenburg, Sweden

8. University/BHF Centre for Cardiovascular Science and Usher Institute, University of Edinburgh, Edinburgh, UK

9. Division of Emergency Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany

10. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria

11. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

12. Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Abstract

Abstract The coronavirus disease 2019 (COVID-19) pandemic has increased awareness that severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2) may have profound effects on the cardiovascular system. COVID-19 often affects patients with pre-existing cardiac disease, and may trigger acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE), acute myocardial infarction (AMI), and acute heart failure (AHF). However, as COVID-19 is primarily a respiratory infectious disease, there remain substantial uncertainty and controversy whether and how cardiovascular biomarkers should be used in patients with suspected COVID-19. To help clinicians understand the possible value as well as the most appropriate interpretation of cardiovascular biomarkers in COVID-19, it is important to highlight that recent findings regarding the prognostic role of cardiovascular biomarkers in patients hospitalized with COVID-19 are similar to those obtained in studies for pneumonia and ARDS in general. Cardiovascular biomarkers reflecting pathophysiological processes involved in COVID-19/pneumonia and its complications have a role evaluating disease severity, cardiac involvement, and risk of death in COVID-19 as well as in pneumonias caused by other pathogens. First, cardiomyocyte injury, as quantified by cardiac troponin concentrations, and haemodynamic cardiac stress, as quantified by natriuretic peptide concentrations, may occur in COVID-19 as in other pneumonias. The level of those biomarkers correlates with disease severity and mortality. Interpretation of cardiac troponin and natriuretic peptide concentrations as quantitative variables may aid in risk stratification in COVID-19/pneumonia and also will ensure that these biomarkers maintain high diagnostic accuracy for AMI and AHF. Second, activated coagulation as quantified by D-dimers seems more prominent in COVID-19 as in other pneumonias. Due to the central role of endothelitis and VTE in COVID-19, serial measurements of D-dimers may help physicians in the selection of patients for VTE imaging and the intensification of the level of anticoagulation from prophylactic to slightly higher or even therapeutic doses.

Funder

Research Excellence Award

Butler Senior Clinical Research Fellowship

British Heart Foundation

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,General Medicine

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