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21/01/2022 - Covid-19

Cardiac damage in COVID-19 patients is an indicator of poor long-term prognosis

Patients who suffer heart damage during a COVID-19 infection are more likely to need to be readmitted to hospital or to die than those who survive the disease without suffering this. This has been revealed by a study led by researchers from Hospital del Mar, the Hospital del Mar Medical Research Institute (IMIM-Hospital del Mar) and the CIBER in Cardiovascular Diseases (CIBERCV), which has been published in the Journal of Clinical Medicine.

Specifically, 12% of the patients studied with this characteristic had to be readmitted to hospital (1 of them died) during the year following their recovery from COVID-19. Among those who did not suffer cardiac damage, just over 1% needed to be readmitted and none died. In view of this fact, Dr. Andrea Izquierdo, a consultant in the Cardiology Department at Hospital del Mar and first author of the study, explains that "We recommend routinely checking heart damage markers in the blood of patients admitted for COVID-19 to help guide treatment, in-hospital management and post-hospital management when the patient is discharged."

From left to right: Núria Ribas, Andrea Izquierdo and Jaume Marrugat

Checking a heart damage marker

For one year, the researchers monitored 86 patients who had been admitted to Hospital del Mar and Hospital Universitari Joan XXIII in Tarragona with COVID-19, and which of them had high levels of troponin in their blood, a protein that is released when there is damage to the heart muscle, the myocardium. This data was compared to 86 other patients admitted for the same reason, but without this problem. The two groups were equivalent in terms of age and sex. In the case of the first group, "Even if the patients had got over COVID-19 and returned home, they were readmitted more and had a higher mortality rate during the first year of follow-up than patients without the cardiac blood damage marker", explains Dr. Izquierdo.

Checking a heart damage marker

In addition, half of the patients who had a high level of this marker underwent tests six months after they were discharged, and it was found that those who had suffered cardiac damage had thicker heart walls, a factor probably related to high blood pressure rather than COVID-19. It should be noted that people with elevated blood troponin levels had a worse baseline situation than those who did not, with more associated comorbidities, such as high blood pressure, chronic renal failure, or episodes of heart failure. For this reason, Dr. Núria Ribas, head of the Coronary Care Unit at Hospital del Mar and one of the authors of the study, points out that this is a group that "needs to be monitored more closely to avoid these readmissions." The readmissions (suffered by 10.5% of patients in this group, compared with 1.2% in the other group) were not COVID-19 related.

This makes troponin levels in the blood a "good indicator of poor long-term prognosis in patients with COVID-19, despite them having overcome the disease, regardless of age and sex", says Dr. Ribas. This cardiac damage indicator had previously been related to the risk of problems in patients during hospitalisation, but not once they had been discharged.

Dr. Jaume Marrugat, a researcher at IMIM-Hospital del Mar and an author of the study, stresses that the advantage of this indicator is that "Since it is relatively cheap and available in all hospitals, performing it in all patients with COVID-19 who require hospitalisation is feasible and offers risk stratification not only during admission, but also in the long term."

Reference article

Izquierdo A, Mojón D, Bardají A, Carrasquer A, Calvo-Fernández A, Carreras-Mora J, Giralt T, Pérez-Fernández S, Farré N, Soler C, Solà-Richarte C, Cabero P, Vaquerizo B, Marrugat J, Ribas N. Myocardial Injury as a Prognostic Factor in Mid- and Long-Term Follow-Up of COVID-19 Survivors. J Clin Med. 2021 Dec 16;10(24):5900. doi: 10.3390/jcm10245900. PMID: 34945196; PMCID: PMC8708676.

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