The association between troponin positivity and adverse clinical outcomes, echocardiographic findings, and mortality in hospitalized patients with COVID-19.

Background: Troponin-I elevation during a COVID-19 infection is likely due to multiple factors. Few studies have investigated the relationship between troponin levels and echocardiographic variables in patients with COVID-19. Our study aimed to evaluate the clinical and paraclinical effects-including echocardiographic findings-of COVID-19 on myocardial injury, as indicated by elevated troponin levels, and to assess its potential impact on in-hospital and three-month outcomes in hospitalized COVID-19 patients.

Methods: In this historical cohort study conducted at the Heart Hospital between 2021 and 2022, 161 hospitalized patients were included-72 with elevated troponin and 89 with normal troponin levels. Daily blood tests assessed complete blood count, electrolytes, blood sugar, CRP, blood urea nitrogen (BUN), and creatinine. All patients underwent transthoracic echocardiography within 24 h of admission to evaluate cardiac parameters, including left atrial and ventricular diameters, left ventricular (LV) ejection fraction, right ventricular (RV) size and function, and pulmonary artery pressure.

Results: The troponin-positive group had a significantly higher prevalence of a history of cardiovascular disease compared to the troponin-negative group (65.3% vs. 40.4%, P = 0.01). Also, blood sugar, white blood cell count, BUN, and creatinine levels were significantly higher in the troponin-positive group (P = 0.035, 0.006, 0.006, and 0.006, respectively). Echocardiographic findings showed a significantly higher prevalence of left ventricular (LV) enlargement, LV systolic dysfunction, right ventricular (RV) systolic dysfunction, pulmonary hypertension, and significant mitral regurgitation in the troponin-positive group (P = 0.006 for all). Three- month mortality [9(23.1%) vs. 4(5.8%), P value = 0.048] was higher in in troponin-positive group than troponin negative group. Moreover, patients in troponin positive group had 6.6 times higher odds of death (OR = 6.64, 95% CI: 1.28-34.37, p = 0.024).

Conclusions: The results of our study suggest that elevated troponin levels in COVID-19 patients may serve as a marker of increased risk for more severe disease, significant left and right ventricular dysfunction, pulmonary hypertension, and higher mortality compared to those without elevated troponin levels.

Clinical Trial Number: Not applicable.