Key result
Elevated troponin in COVID-19 is linked to poor prognosis and immune-driven dilated cardiomyopathy risk.
Elevated troponin in COVID-19 patients indicates myocardial injury and is associated with high mortality, highlighting the need for long-term cardiac monitoring for the potential development of dilated cardiomyopathy.
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Supports monitoring for myocardial injury in COVID-19; hypothesis-generating for dilated cardiomyopathy risk from immune activation.
Multiple lines of evidence have shown that elevated blood troponin is strongly associated with poor prognosis in patients with the novel coronavirus disease 2019 (COVID-19). Possible mechanisms of myocardial injury in COVID-19 include ischaemia due to circulatory and respiratory failure, epicardial or intramyocardial small coronary artery thrombotic obstruction due to increased coagulability, and myocarditis caused by systemic inflammation or direct binding of the virus to its receptor, angiotensin-converting enzyme-2 (ACE2), which is abundantly expressed in the heart. It is postulated that persistent immune activation upon viral infection increases the risk of developing dilated cardiomyopathy in COVID-19 patients.
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Komiyama et al. (2020) conducted a review in COVID-19. Elevated blood troponin is strongly associated with poor prognosis in patients with COVID-19, and persistent immune activation upon viral infection may increase the risk of dilated cardiomyopathy.
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