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Cardiac Troponin for the Diagnosis and Risk-Stratification of Myocardial Injury in COVID-19: JACC Review Topic of the Week
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.jacc.2020.06.068 Yader Sandoval 1 , James L Januzzi 2 , Allan S Jaffe 3
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.jacc.2020.06.068 Yader Sandoval 1 , James L Januzzi 2 , Allan S Jaffe 3
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Increases in cardiac troponin indicative of myocardial injury are common in patients with coronavirus disease-2019 (COVID-19) and are associated with adverse outcomes such as arrhythmias and death. These increases are more likely to occur in those with chronic cardiovascular conditions and in those with severe COVID-19 presentations. The increased inflammatory, prothrombotic, and procoagulant responses following severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection increase the risk for acute nonischemic myocardial injury and acute myocardial infarction, particularly type 2 myocardial infarction, because of respiratory failure with hypoxia and hemodynamic instability in critically ill patients. Myocarditis, stress cardiomyopathy, acute heart failure, and direct injury from SARS-CoV-2 are important etiologies, but primary noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis, probably cause more of the myocardial injury. The structured use of serial cardiac troponin has the potential to facilitate risk stratification, help make decisions about when to use imaging, and inform stage categorization and disease phenotyping among hospitalized COVID-19 patients.
中文翻译：
心脏肌钙蛋白用于 COVID-19 心肌损伤的诊断和风险分层：本周 JACC 评论主题
表明心肌损伤的心肌肌钙蛋白增加在 2019 冠状病毒病 (COVID-19) 患者中很常见，并且与心律失常和死亡等不良结局相关。这些增加更有可能发生在患有慢性心血管疾病的人和患有严重 COVID-19 的人中。严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染后炎症、促血栓形成和促凝血反应增加，增加了急性非缺血性心肌损伤和急性心肌梗死的风险，特别是 2 型心肌梗死，因为呼吸衰竭危重患者的缺氧和血流动力学不稳定。心肌炎、应激性心肌病、急性心力衰竭和 SARS-CoV-2 直接损伤是重要的病因，但原发性非心脏疾病，如肺栓塞、危重疾病和败血症，可能会导致更多的心肌损伤。系列心肌肌钙蛋白的结构化使用有可能促进风险分层，帮助决定何时使用成像，并为住院 COVID-19 患者的分期分类和疾病表型提供信息。
更新日期：2020-09-01
中文翻译：
心脏肌钙蛋白用于 COVID-19 心肌损伤的诊断和风险分层：本周 JACC 评论主题
表明心肌损伤的心肌肌钙蛋白增加在 2019 冠状病毒病 (COVID-19) 患者中很常见，并且与心律失常和死亡等不良结局相关。这些增加更有可能发生在患有慢性心血管疾病的人和患有严重 COVID-19 的人中。严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染后炎症、促血栓形成和促凝血反应增加，增加了急性非缺血性心肌损伤和急性心肌梗死的风险，特别是 2 型心肌梗死，因为呼吸衰竭危重患者的缺氧和血流动力学不稳定。心肌炎、应激性心肌病、急性心力衰竭和 SARS-CoV-2 直接损伤是重要的病因，但原发性非心脏疾病，如肺栓塞、危重疾病和败血症，可能会导致更多的心肌损伤。系列心肌肌钙蛋白的结构化使用有可能促进风险分层，帮助决定何时使用成像，并为住院 COVID-19 患者的分期分类和疾病表型提供信息。
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