Characterization and Prognostic Role of Myocardial Injury in Patients With COVID-19. The CardioCOVID Gemelli Study.

Background:

Coronavirus disease-2019 (COVID-19) is a global pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is resulting in substantial morbidity and mortality (1). Of interest, a significant proportion of patients presenting with COVID-19 infection and requiring hospitalization demonstrate biomarker evidence of myocardial injury (defined as elevation in circulating cardiac troponin levels), which has been shown to be associated with increased risk of in-hospital morbidity (i.e.: rate of non- invasive and invasive ventilation, access to intensive care unit, length of hospitalization, use of glucocorticoids or antibiotics) and mortality (2-6). The pathogenesis of myocardial injury in COVID-19 is still unclear, with proposed mechanisms that include cytokine-mediated damage, oxygen supply-demand imbalance, ischemic injury from microvascular thrombi formation and direct viral invasion of the myocardium (7-9). Notably, the clinical predictors of myocardial injury in COVID-19 infection are still unknown, and, therefore, there is lack of therapeutic opportunities to prevent or reduce myocardial injury and the related-unfavourable outcomes.

Moreover, the post-acute sequelae of COVID-19 could potentially involve the pulmonary and several extrapulmonary organs, including the cardiovascular system (10). A few studies <<to date have investigated cardiovascular outcomes in the post-acute phase of the COVID-19, and most with a short duration of follow-up and a narrow selection of cardiovascular outcomes (11-13). Therefore, a comprehensive assessment of post-acute COVID-19 sequelae on the cardiovascular system is still missing and, of interest, studies addressing the post-acute COVID-19 sequelae in patients who developed myocardial injury during COVID-19 infection are lacking (14).

Given these shortcomings in this evolving area of clinical research, a comprehensive characterization of myocardial injury in patients with COVID-19 infection and the identification of clinical predictors for its occurrence could allow the development of predictive models, thus helping clinicians in the disease phenotyping and the early assessment of the risk of unfavourable outcome and improving a fast determination of most appropriate treatments and clinical paths, efficient planning and use of clinical resources in terms of treatment type and units (such as intensive care or coronary intensive care). In addition, the identification of clinical predictors and/or protective factors for myocardial injury in COVID-19 infection may pave the way for the development of specific therapeutic strategies aiming to reduce the impact of myocardial injury on COVID-19-related morbidity and mortality. Finally, assessing the long-term cardiovascular impact of myocardial injury in COVID-19 infection could help clinicians in the prognostic stratification and the choice of therapeutic strategies in the post-acute COVID-19 phases, possibly identifying those patients that may need a more aggressive therapy and a closer follow-up.

OBJECTIVES