Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-06-21 , DOI: 10.1186/s13613-022-01030-8 Saga Jansson 1 , Patrik Johansson Blixt 1 , Helen Didriksson 1 , Carina Jonsson 1 , Henrik Andersson 1 , Cassandra Hedström 2 , Jan Engvall 2 , Meriam Åstrom Aneq 2 , Michelle S Chew 1
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Background
Previous studies have found an increase in cardiac troponins (cTns) and echocardiographic abnormalities in patients with COVID-19 and reported their association with poor clinical outcomes. Whether acute injury occurs during the course of critical care and if it is associated with cardiac function is unknown.
The purpose of this study was to document the incidence of acute myocardial injury (AMInj) and echocardiographically defined left ventricular (LV) and right ventricular (RV) systolic dysfunction in consecutive patients admitted to an intensive care unit (ICU) for COVID-19. The relationship between AMInj and echocardiographic abnormalities during the first 14 days of ICU admission was studied. Finally, the association between echocardiographic findings, AMInj and clinical outcome was evaluated.
Methods
Seventy-four consecutive patients (≥18 years) admitted to the ICU at Linköping University Hospital between 19 Mar 2020 and 31 Dec 2020 for COVID-19 were included. High-sensitivity troponin-T (hsTnT) was measured daily for up to 14 days. Transthoracic echocardiography was conducted within 72 h of ICU admission. Acute myocardial injury was defined as an increased hsTnT > 14ng/l and a > 20% absolute change with or without ischaemic symptoms. LV and RV systolic dysfunction was defined as at least 2 abnormal indicators of systolic function specified by consensus guidelines.
Results
Increased hsTnT was observed in 59% of patients at ICU admission, and 82% developed AMInj with peak levels at 8 (3–13) days after ICU admission. AMInj was not statistically significantly associated with 30-day mortality but was associated with an increased duration of invasive mechanical ventilation (10 (3–13) vs. 5 days (0–9), p=0.001) as well as ICU length of stay (LOS) (19.5 (11–28) vs. 7 days (5–13), p=0.015). After adjustment for SAPS-3 and admission SOFA score, the effect of AMInj was significant only for the duration of mechanical ventilation (p=0.030).
The incidence of LV and RV dysfunction was 28% and 22%, respectively. Only indices of LV and RV longitudinal contractility (mitral and tricuspid annular plane systolic excursion) were associated with AMInj. Echocardiographic parameters were not associated with clinical outcome.
Conclusions
Myocardial injury is common in critically ill patients with COVID-19, with AMInj developing in more than 80% after ICU admission. In contrast, LV and RV dysfunction occurred in approximately one-quarter of patients. AMInj was associated with an increased need for mechanical ventilation and ICU LOS but neither AMInj nor ventricular dysfunction was significantly associated with mortality.
中文翻译：
重症 COVID-19 患者急性心肌损伤的发生率及其与左右心室收缩功能障碍的关系
背景
先前的研究发现 COVID-19 患者的心肌肌钙蛋白 (cTns) 和超声心动图异常增加，并报告了它们与不良临床结果的关联。在重症监护过程中是否发生急性损伤以及是否与心脏功能有关尚不清楚。
本研究的目的是记录因 COVID-19 入住重症监护病房 (ICU) 的连续患者的急性心肌损伤 (AMinj) 和超声心动图定义的左心室 (LV) 和右心室 (RV) 收缩功能障碍的发生率。研究了 ICU 入院前 14 天 AMInj 与超声心动图异常之间的关系。最后，评估了超声心动图结果、AMInj 和临床结果之间的关联。
方法
纳入了 2020 年 3 月 19 日至 2020 年 12 月 31 日期间因 COVID-19 入住林雪平大学医院 ICU 的 74 名连续患者（≥18 岁）。每天测量高敏肌钙蛋白-T (hsTnT) 长达 14 天。入ICU后72小时内进行了经胸超声心动图检查。急性心肌损伤定义为 hsTnT 增加 > 14ng/l 和 > 20% 的绝对变化，伴有或不伴有缺血症状。LV 和 RV 收缩功能障碍被定义为共识指南规定的至少 2 个收缩功能异常指标。
结果
59% 的患者在 ICU 入院时观察到 hsTnT 升高，82% 的患者在 ICU 入院后 8（3-13）天出现 AMInj，达到峰值。AMInj 与 30 天死亡率无统计学显着相关性，但与有创机械通气时间延长（10 (3-13) 对 5 天 (0-9)，p = 0.001）以及 ICU 住院时间延长相关(LOS) (19.5 (11-28) 与 7 天 (5-13)，p = 0.015)。在调整 SAPS-3 和入院 SOFA 评分后，AMInj 的效果仅在机械通气期间显着（p = 0.030）。
LV 和 RV 功能障碍的发生率分别为 28% 和 22%。只有 LV 和 RV 纵向收缩力指数（二尖瓣和三尖瓣环平面收缩偏移）与 AMInj 相关。超声心动图参数与临床结果无关。
结论
心肌损伤在 COVID-19 重症患者中很常见，AMInj 在 ICU 入院后发生率超过 80%。相比之下，大约四分之一的患者出现左室和右室功能障碍。AMInj 与机械通气和 ICU LOS 需求的增加相关，但 AMInj 和心室功能障碍均与死亡率显着相关。
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