RESUMO
Background Biochemical markers of cardiac injury and strain are proven indicators of severe COVID-19. Whether enzyme elevation is a product of cardiopulmonary strain versus myocardial viral injury is not well defined. CARDIO-COVID is a registry designed to study COVID-19 patients admitted to ICUs with evidence of cardiac injury. Methods Inclusion criteria for the CARDIO-COVID registry are PCR positive test for SARS-CoV2, ICU admission and either elevated troponin, elevated NT-proBNP/BNP, or new onset heart failure. Registry contains 1328 cases from 16 centers in the US, Canada, and Europe. 838 cases were included for analysis. Cases were collected between March 2020 - May 2021. Multivariate regression analyses were performed. Results Patients were 51.3% male, average age of 67.4 years and 32% Caucasian. 63% had pre-existing cardiovascular disease. Morbidity and mortality were common: 40% died, 50% underwent intubation, 20% required renal replacement therapy, and 5% had cardiac arrest requiring CPR. New onset arrhythmias were common (26%), but VT/VF was rare (4.8%). Cardiovascular complications were minor drivers of morbidity: 4.8% had ACS requiring catheterization, 8.0% had new onset heart failure (median EF 43% (IQR 31 - 47.75%), 4.4% had a CVA, and 6.7% had PE. Of patients who died, 65% died from hypoxemic respiratory failure, 10.5% from septic shock, 9.3% from PEA, and 3.1% from cardiogenic shock. Modeling showed insignificant increased odds of death in patients with MACE (p-value 0.22, OR 1.94 CI 0.67 - 5.82). Age (p-value 0.005) and intubation (p-value 0.001, OR 5.8 CI 2.1 - 18) were strongest predictors of death. Every increase in age by one year was associated with 5% increase in odds of death. Degree of cardiac enzyme elevation was not associated with MACE, death, or intubation. Conclusion While elevated cardiac enzymes are common in severe COVID-19, cardiac complications are not common drivers of mortality. Respiratory failure and septic shock are leading causes of death. These findings suggest that in severe COVID-19 cardiac enzyme elevation usually reflects cardiopulmonary strain from respiratory distress rather than myocardial injury portending cardiac failure or death.Copyright © 2023 American College of Cardiology Foundation