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. 2020 Aug 22;22(11):1994–2006. doi: 10.1002/ejhf.1967

Table 2.

Clinical studies on COVID‐19 with myocardial injury information

Cohort Myocardial injury Severity/prognosis Troponin and other evidence Ref.

Wuhan, China

Mortality: 15.0%

n = 41

5/41 (12.2%)

Definitions: blood levels of hs‐TnI above the 99th percentile upper reference limit or new abnormalities on electrocardiography and echocardiography

 30.8% ICU vs. 3.6% non‐ICU patients with myocardial injury

  • hs‐TnI levels (pg/mL): 3.3 (IQR 3.0–163.0) vs. 3.5 (IQR 0.7–5.4) in ICU and non‐ICU patients (reference: <28 pg/mL)

  • Electrocardiography and echocardiography: not given

 5

Wuhan, China

Mortality: 4.3%

n = 138

10/138 (7.2%)

Definitions: blood levels of TnI above the 99th percentile upper reference limit or new abnormalities on electrocardiography and echocardiography

 22.2% ICU vs. 2.0% non‐ICU patients with myocardial injury

  • TnI levels (pg/mL): 11.0 (IQR 5.6–26.4) vs. 5.1 (IQR 2.1–9.8) in ICU and non‐ICU patients (reference: <26.2 pg/mL)

  • Electrocardiography and echocardiography: not given

 9

Wuhan, China

Mortality: 61.5%

n = 53

12/52 (23.1%)

Definitions: blood levels of hs‐TnI above the 99th percentile upper reference limit

 28.1% non‐survivors vs. 15.0% survivors with myocardial injury

  • hs‐TnI levels (pg/mL): 161.0 (IQR 41.8–766.1) in all patients (reference: <28 pg/mL)

 10

Wuhan, China

Mortality: 28.3%

n = 191

24/145 (16.6%)

Definitions: blood levels of hs‐TnI above the 99th percentile upper reference limit or new abnormalities on electrocardiography and echocardiography

 46.0% non‐survivors vs. 11% survivors with myocardial injury

  • hs‐TnI levels (pg/mL): 22.2 (IQR 5.6–83.1) vs. 3 (IQR 1.1–5.5) in non‐survivors and survivors (reference: <28 pg/mL)

  • Electrocardiography and echocardiography: not given

 11

Wuhan, China

Mortality: 57/97 (58.8%) a

n = 416

82/416 (19.7%)

Definitions: blood levels of hs‐TnI above the 99th percentile upper reference limit, regardless of electrocardiographic and echocardiographic findings

 Myocardial injury is an independent risk factor for mortality with COVID‐19 (HR 4.26, 95% CI 1.92–9.49)

  • hs‐TnI levels (ng/mL): 0.19 (IQR 0.08–1.12) in myocardial injury patients (reference: <0.04 ng/mL)

  • NT‐proBNP levels (pg/mL):1689 (IQR 698–3327) in myocardial injury patients (reference: <900 pg/mL)

  • Electrocardiography d : 14/14 patients with myocardial injury showed findings compatible with myocardial ischaemia

  • Echocardiography: not given

 12

Wuhan, China

Mortality: 12.5%

n = 112

42/112 (37.5%) b

Definitions: blood levels of TnI above the 99th percentile upper reference limit

  • Peak TnI and NT‐proBNP levels present HR 8.9 (95% CI 1.9–40.6) and HR 1.2 (95% CI 1.1–1.3) for the risk of death

  • No dynamic change in TnI and NT‐ proBNP levels observed during hospitalization

  • TnI levels (ng/mL): 0.10 (IQR 0.01–0.77) vs. 0.00 (IQR 0.00–0.01) in severe and non‐severe patients (reference: <0.12 ng/mL)

  • NT‐proBNP levels (ng/L): 1142.0 (IQR 388.3–5956.5) vs. 101.9 (IQR 34.0–363.8) in severe and non‐severe patients (reference: <1800 ng/L)

  • Electrocardiography: 19.6% non‐specific ST‐T changes and 29.5% tachycardia in all patients

  • Echocardiography: all abnormalities can be explained by underlying conditions except for a small amount of pericardial effusion

 13

Wuhan, China

Mortality: 7.3%

n = 150

22/150 (14.7%)

Definitions: blood levels of TnI above the 99th percentile upper reference limit

 Myocardial injury is an independent risk factor for mortality with COVID‐19 (HR 26.91, 95% CI 4.09–177.23)

  • TnI levels (ng/L): 68.5 (IQR 9.3–693.3) vs. 4.5 (IQR 2.7–10.0) in severe and non‐severe patients (reference: <26.3 ng/L)

  • NT‐proBNP levels (ng/L): 1030 (IQR 339–2276) vs. 83 (IQR 28–232) in severe and non‐severe patients (reference: <973 ng/L if <45 years; <1210 ng/L if 45–54 years; <1980 ng/L if 55–64 years; <2850 ng/L if 65–74 years; <5260 ng/L if ≥75 years)

 14

Wuhan, China

Mortality: 34.1%

n = 176

49/176 (27.8%)

Definitions: blood levels of TnI above the 99th percentile upper reference limit

 Myocardial injury is an independent risk factor for mortality with COVID‐19 (OR 6.93, 95% CI 1.83–26.22)

  • TnI levels (ng/L): not given (reference: not given)

 15

Wuhan, China

Mortality: 9.2%

n = 671

106/671 (15.8%)

Definitions: blood levels of TnI above the 99th percentile upper reference limit

 TnI >0.026 ng/mL (HR 4.56, 95% CI 1.28–16.28) and NT‐proBNP >900 pg/mL (HR 3.12, 95% CI 1.25–7.80) are independent risk factors for mortality with COVID‐19

  • TnI levels (ng/mL): 0.235 (IQR 0.042–1.996) vs. 0.006 (IQR 0.006–0.011) in non‐survivors and survivors (reference: <0.04 ng/mL)

  • NT‐proBNP levels (pg/mL): 1819 (IQR 759–5164) vs. 132 (IQR 58–237) in non‐survivors and survivors (reference: <900 pg/mL)

 16

Wuhan, China

Mortality: 23.0%

n = 187

52/187 (27.8%)

Definitions: blood levels of TnT above the 99th percentile upper reference limit

 Dynamic increase of TnI and NT‐proBNP levels observed during hospitalization in non‐survivors

  • TnT levels (ng/mL): not given (reference: not given)

  • NT‐proBNP levels (pg/mL): 817.4 (IQR 336.0–1944.0) vs. 141.4 (IQR 39.3–303.6) in non‐myocardial and myocardial injury patients (reference: not given)

 17

Wuhan, China

Mortality: 10.0%

n = 25

11/15 (73.3%)

Definitions: blood levels of hs‐TnI above the 99th percentile upper reference limit

 77.8% of hs‐TnI levels in the last test increased compared with that in the first test

  • hs‐TnI levels (mmol/L): 316 (IQR 57–5420) in all patients (reference: <40 mmol/L)

  • NT‐proBNP levels (pg/mL): 2450 (IQR 881–7992) in all patients (reference: <125 pg/mL if <75 years; <450 pg/mL if >75 years)

 18

Wuhan, China

Mortality: 10.0%

n = 92

31/91 (34.1%) c

Definitions: blood levels of TnI above the 99th percentile upper reference limit

 Myocardial injury is common in non‐survivors

  • TnI levels (ng/mL): 2.47 (IQR 0.13–92.40) in myocardial injury patients (reference: <0.04 ng/mL)

 19

Multi‐centre in China

Mortality: 8.0%

n = 476

86/384 (22.4%)

Definitions: blood levels of TnI/T above the 99th percentile upper reference limit

 36.2%, 24.4% and 19.9% patients with myocardial injury in critical, severe and moderate groups

  • TnI/T levels: not given (reference e : TnI: <0.04 ng/mL; TnT: <28 pg/mL)

 20

New York, USA

Mortality: 553/2634 (21.0%) a

n = 5700

801/3533 (22.6%)

Definitions: blood levels of TnI/T above the 99th percentile upper reference limit

 –

  • TnI/T levels: not given (reference e : not given)

  • NT‐proBNP levels (pg/mL): 385.5 (IQR 106–1996.8) in all patients (reference: <99 pg/mL)

 21

CI, confidence interval; COVID‐19, coronavirus disease 2019; HR, hazard ratio; hs‐TnI, high‐sensitivity troponin I; ICU, intensive care unit; IQR, interquartile range; NT‐proBNP, N‐terminal pro B‐type natriuretic peptide; OR, odds ratio; TnI/T, troponin I/T.

a

Mortality is counted in patients with known outcome (discharged or deceased). Patients who remained hospitalized at the final follow‐up date are not included.

b

One of 42 COVID‐19 patients with elevated biomarkers was diagnosed as myocardial infarction.

c

Six of 31 COVID‐19 patients with elevated biomarkers were diagnosed as myocardial infarction.

d

Electrocardiogram was performed during the periods of cardiac biomarker elevation.

e

Reference ranges were different in separate centres.