TROPONIN MYOCARDIAL INJURY MARKER AND OUTCOME IN COVID-19: SCOPING REVIEW

Rodrigues, Andreia Aparecida; Cardoso, Joana Darc Chaves; Miraveti, Jocilene de Carvalho; Cenzi, Camila Maria

doi:10.1590/ce.v28i0.90072

person Andreia Aparecida Rodrigues

conception · design of the work · acquisition · analysis · interpretation of data for the work · Drafting the work or revising it critically for important intellectual content · Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

schoolUniversidade Federal de Mato Grosso, Faculdade de Enfermagem, Cuiabá, MT, Brasil

0000-0001-7533-6359

person Joana Darc Chaves Cardoso

Drafting the work or revising it critically for important intellectual content · Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

schoolUniversidade Federal de Mato Grosso, Faculdade de Enfermagem, Cuiabá, MT, Brasil

0000-0003-1989-4043

person Jocilene de Carvalho Miraveti

Drafting the work or revising it critically for important intellectual content · Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

schoolUniversidade Federal de Mato Grosso, Faculdade de Enfermagem, Cuiabá, MT, Brasil

0000-0002-5432-4890

person Camila Maria Cenzi

conception · design of the work · acquisition · analysis · interpretation of data for the work · Drafting the work or revising it critically for important intellectual content · Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

schoolUniversidade Federal de Mato Grosso, Faculdade de Enfermagem, Cuiabá, MT, Brasil

0000-0003-3277-2972

Associate editor: Dra. Luciana Kalinke

Corresponding author: Camila Maria Cenzi, Universidade Federal de Mato Grosso, Faculdade de Enfermagem, Av. Fernando Correa da Costa, 2367, E-mail:
camilacenzi@gmail.com

Database	Search strategy
PUBMED	Troponin AND COVID-19 AND Cardiovascular System
MEDLINE	Troponin AND COVID-19 AND Cardiovascular System
SCIELO	Troponin AND COVID-19 AND Cardiovascular System

Authors/Country/ Year	Title	Journal	Design / Sample / Change in troponin and clinical outcome
Alieva, et al⁶. Russia 2022	Prognostic value of cardiac troponins in case of COVID-19.	Therapy	Retrospective Study 48,510 medical records Elevated serum troponin levels were correlated with deteriorating health and increased mortality in patients with and without heart disease. Troponin elevation was associated with death, mechanical ventilation, and intensive care.
Almeida, et al⁷. Brazil 2020	Prognostic Value of Troponin-T and B-Type Natriuretic Peptide in Patients Hospitalized for COVID-19	Arquivos Brasileiros de Cardiologia	Cohort study with convenience sample 183 patients First study in Brazil to identify TnT as an independent predictor of worse prognosis in patients with COVID-19. Troponin elevation was associated with the combined outcome of death or need for mechanical ventilation, with more than half of patients with troponin > 0.03 ng/dl having an unfavorable outcome.
Azevedo, et al⁸. Brazil 2021	Practical Approach to Acute Coronary Syndrome in Patients with COVID-19	International Journal of Cardiovascular Sciences	Scoping review 59 studies Acute myocardial injury is significantly associated with in-hospital mortality, with troponin being a marker of worse prognosis in SARS-CoV-2 infected patients. Several studies have shown that myocardial injury, diagnosed by increased troponin levels, is associated with higher mortality in patients with COVID-19.
Bavish, et al⁹. United States 2020	Acute myocardial injury in patients hospitalized with Covid-19 infection: A review.	Progress in Cardiovascular Diseases	Review study 26 articles (11,685 patients) Elevation of cardiac biomarkers was found to be common in patients with Covid-19 infection. In this review, the overall prevalence of acute myocardial injury ranged from 5% to 38%. Elevation of cardiac biomarkers, particularly high-sensitivity cardiac troponin (hs-troponin) was considered an important myocardial injury marker for diagnosis and risk stratification.
Cao, et al¹⁰. China 2020	Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19.	Theragnostic	Review study 26 articles (11,685 patients) Elevation of cardiac biomarkers was found to be common in patients with Covid-19 infection. In this review, the overall prevalence of acute myocardial injury ranged from 5% to 38%. Elevation of cardiac biomarkers, particularly high-sensitivity cardiac troponin (hs-troponin) was considered an important myocardial injury marker for diagnosis and risk stratification.
Carillo-Esper, et al¹. Mexico 2020	Manifestaciones extrapulmonares de la infección por SARS-CoV-2.	Cirugía Y Cirujanos	Theoretical study Cardiac biomarker studies suggest a high prevalence of cardiac injury in patients hospitalized for Covid-19, with myocardial injury being an important prognostic factor.
Case, et al¹¹. United States 2021	Clinical impact and predictors of troponin elevation in patients with Covid-19	Cardiovascular Revascularization Medicine	Cohort study 2,716 patients with Covid-19 Of the sample, 250 had troponin elevation, presenting a higher risk for mechanical ventilation. Hospital mortality was significantly higher (48.4%) in COVID-19 positive patients with troponin elevation than without troponin elevation (12.2%; p<0.001).
Chen, et al¹². . China 2020	Cardiovascular manifestations in severe and critical patients with COVID-19.	Clinical Cardiology	Incidence study 54 patients with COVID-19 Troponin elevation was observed in 23 (42.6%) patients, with three patients having highly elevated values (>3 times the upper reference limit), indicative of severe myocardial injury, and all being classified as critical cases.
Fan, et al¹³. China 2019	Risk factors for myocardial injury in patients with coronavirus disease 2019 in China.	Esc Heart Failure	Cohort study 353 patients with COVID-19 Of the sample, 79 patients had myocardial injury. High troponin levels were significantly associated with immune response, multiple organ dysfunction and poor outcomes.
Kaufmann, et al¹⁴. Austria 2022	Biomarkers Associated with Cardiovascular Disease in COVID-19.	Cells	Theoretical study The prognostic value of troponin in COVID-19 patients has been consistently demonstrated in several different study populations worldwide and has been confirmed by data from several meta-analyses. In the case of myocardial injury, a clear correlation with symptoms and signs of myocardial ischemia (chest pain, ECG, and echocardiogram) is necessary to adequately guide management decisions.
Kavsak, et al¹⁵. Canada 2021	Cardiac Troponin Testing in Patients with COVID-19.	Clinical Chemistry	Theoretical study After respiratory complications, cardiac complications were the most prevalent finding in COVID-19 patients. Increased troponin (based on a threshold of 28 ng/L) at hospital admission may have a greater association with death.
Lala, et al¹⁶. United States 2020	Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection	Journal of the American college of cardiology	Cohort study 3,069 patients hospitalized with Covid-19 Myocardial injury reflected by troponin concentrations above the upper reference limit of 0.03 ng/ml was present in 36% of patients hospitalized with COVID-19. Troponin levels among patients were generally <1.0 ng/ml. Even small amounts of myocardial injury (for example) troponin I >0.09 ng/dl, n = 530 [19.4%]) were associated with a more pronounced risk of death.
Luchian, et al¹⁷. Bélgica 2021	Troponin T in COVID-19 hospitalized patients: Kinetics matter	Cardiology Journal	Prospective study 202 patients Elevated cardiac troponin T on admission was associated with increased in-hospital mortality, whereas patients with troponin levels within the standards had less cardiovascular changes. The study emphasizes the additional role of cTnT testing in COVID-19 patients for risk stratification and improved diagnostic and management pathway.
Majure, et al¹⁸. United States 2021	Usefulness of Elevated Troponin to Predict Death in Patients With COVID-19 and Myocardial Injury	The American Journal of Cardiology	Analytical study 6,247 hospitalized patients with Covid-19 Of the sample, 4426 (71%) patients had normal troponin result, 919 (15%) mildly elevated and 902 (14%) had severely elevated troponin. Patients hospitalized with COVID-19 and elevated troponin had markedly increased mortality compared with patients with normal troponin levels. This risk was independent of cardiovascular comorbidities and elevated markers of inflammation.
Marzo, et al¹⁹. Italia 2021	Prevalence and prognostic value of cardiac troponin in elderly patients hospitalized for COVID-19.	Journal of Geriatric Cardiology	Retrospective study 343 patients Of the sample, 88 (25.7%) had troponin results above the upper reference limit (0.046 μg/L). Patients with elevated troponin had more comorbidities, greater impaired respiratory exchange, and higher inflammatory markers on admission than those with troponin levels within standards. In addition, they died more (73.9% vs. 37.3%, P < 0.001) over 15 (6-25) days of hospitalization.
Nascimento, et al²⁰. Brazil 2020	Troponina Cardíaca como Preditor de Injúria Miocárdica e Mortalidade por COVID-19	Arquivos Brasileiros de Cardiologia	Editorial. Myocardial injury is not uncommon in patients with COVID-19, and elevated cardiac troponin is a predictor of in-hospital mortality. The measurement of cTnI throughout hospitalization can facilitate the risk classification of these patients, with the advantage of being an easily reproducible method.
Rezabakhsh, et al²¹. Iran 2022	A close-up view of dynamic biomarkers in the setting of COVID-19: Striking focus on cardiovascular system.	Journal of Cellular Molecular Medicine	Theoretical study Some evidence has suggested that a significantly high rate of cTnI induced by cardiac dysfunction could be considered an independent predictor of mortality from Covid-19. Troponin results could be applied for risk stratification on admission and assessment of disease progression in hospitalized patients.
Sahranavard, et al²². Iran 2021	Cardiac Complications in COVID-19: A Systematic Review and Meta-analysis	Archives of Iranian Medicine	Systematic review 22 articles included Comparisons of troponin levels between survivors and patients who died were performed in four studies, and the results showed that patients who died had higher troponin levels compared to survivors.
Shafi, et al²³. England 2020	Cardiac manifestations in COVID-19 patients - A systematic review	Journal of Cardiac Surgery	Systematic review 61 articles included A wide range of cardiac manifestations are associated with the interaction between Covid-19 and the cardiovascular system. Specific cardiac biomarkers, such as troponin, provide a useful prognostic tool to help identify patients with severe disease early and allow timely treatment escalation.
Shah, et al²⁴. United States 2020	Prognostic Value of Elevated Cardiac Troponin I in Hospitalized Covid-19 Patients	American Journal of Cardiology	Retrospective study 635 medical records of patients with Covid-19 In 309 patients, troponin I was measured at least once during hospitalization. Of these patients, 116 (37.5%) had elevated troponin I, and were found to have a higher need for intubation, dialysis, and ICU transfer. In addition, overall mortality was significantly higher among patients with elevated cTnI.
Sharma, et al²⁵. India 2021	Cardiovascular manifestations of COVID-19: An evidence-based narrative review	Indian Journal of Medical Research	Theoretical study Troponin elevation is associated with increased incidence of malignant arrhythmias and mortality from Covid-19. In the initial report from Wuhan, China, up to 27.8% of Covid-19 patients had an elevated troponin level, indicating myocardial damage during hospitalization.
Tersalvi, et al²⁶. Switzerland 2020	Elevated Troponin in Patients with Coronavirus Disease 2019: Possible Mechanisms	Journal of Cardiac Failure	Theoretical study Elevated troponin levels are frequent in Covid-19 patients and significantly associated with fatal outcomes. Several mechanisms may explain this phenomenon: viral myocarditis, cytokine-induced myocardial injury, microangiopathy and unmasked coronary artery disease.
Tuo, et al³. China 2021	Cardiac Biomarker Abnormalities Are Closely Related to Prognosis in Patients with COVID-19	International Hearth Journal	Observational study 148 patients The incidence of cardiovascular complications happened in 19 patients (12.8%). Five of them were survivors (5.2%) and 14 of them were non-survivors (26.9%). Compared to survivors, non-survivors had higher levels of high-sensitivity cardiac troponin I.