Table 3
Discussion Results of aforementioned studies underline how cardiac biomarkers,
such as TnT, NT-pro-BNP and CK-MB are associated with severe form of
COVID-19 infection. Above all, higher levels of these biomarkers are
significantly associated with an increased risk of the mortality in
COVID-19 infected patients (Table 4). Therefore, has been demonstrated
COVID-19 infection is more severe in those patients with a previous
history of arterial hypertension, cardiovascular diseases[8],
[9], [13]–[15], [31].
In addition to classical laboratory parameters evaluated in COVID-19
infection, such as C Reactive Protein (CRP), D-Dimer, and lactate
dehydrogenase (LDH), which are currently used in clinical practice,
others biomarkers could potentially be useful for screening, clinical
management, and prevention of serious complications.
Among the biomarkers mentioned above, the most important parameter to
consider as a prediction of mortality is TnT. Infact the highest
mortality was found in patients with progressively increasing troponin
levels and a history of cardiovascular disease[8], [9],
[31], [33].
Moreover, some pathophysiological bases have been hypothesized regarding
the elevation of TnT levels in patients with COVID-19 infection: the
instability of pre-existing atherosclerotic plaques resulting from the
phenomenon of cytokine storm with a characteristic clinical picture of
type 1 myocardial infarction[34], [35], a marked increase in
oxygen demand by cardiomyocytes, in a situation of tissue hypoxia, with
consequent ischemia that configures a picture of type 2 myocardial
infarction[34] ; a direct myocardial damage with a picture of
fulminant myocarditis (coronary artery disease)[36], [37] ,
effect of sepsis / cytokine storm and endothelial damage[38].
These hypotheses were proposed following the absence of viral genomes in
cardiomyocytes and the presence of mononuclear inflammatory cells from
autopsy findings[30].
Therefore, it is clinically significant that fluctuating levels of
myocardial biomarkers are closely monitored and patients with high
levels of myocardial biomarkers are treated promptly to improve
prognosis[39]–[41].
At the end, on basis of symptoms and cardiac biomarkers patients could
be divided as follows:
- Mild : patient has mild symptoms (fever, cough, headache,
anosmia and / or ageusia) and possible or not pneumonia on X-Ray imaging
with normal cardiac biomarkers.
- Severe : patient with respiratory distress, Respiratory
Rate ≥ 30 beats/minute in a resting state, mean oxygen saturation ≤93%,
and an arterial blood oxygen partial pressure
(PaO2)/oxygen concentration
(FiO2) ≤ 300 mm Hg with normal or high cardiac
biomarkers.
- Critical : patient is characterized by respiratory failure and
required mechanical ventilation, the occurrence of shock, and the
combined failure of other organs that required Intensive Care Unit (ICU)
monitoring and treatment with significantly elevated cardiac
biomarkers[42], [43].