Title: A Study on electrographic abnormalities and troponin elevation in COVID-19 patients: A Bangladeshi Perspective

Authors: Dr Syeda Masuma Kawsar, Dr Amirul Islam Bhuyan

 DOI: https://dx.doi.org/10.18535/jmscr/v12i03.03

Abstract

Background: In Bangladesh, COVID-19 patients frequently present with electrographic abnormalities and elevated troponin levels, indicative of cardiac stress. These observations highlight the virus's potential impact on cardiovascular health, necessitating vigilant monitoring and timely interventions to mitigate complications.

Study Objective: This research aims to assess electrographic abnormalities and troponin elevation in COVID-19 patients within Bangladesh.

Methods: Conducted retrospectively at a tertiary medical college and hospital, our study enrolled 100 consecutive adult COVID-19 patients. We analyzed baseline characteristics, lab results, and serial ECGs. Troponin I concentrations were measured using the Abbott Architect method (normal range: ≤0.05 ng/mL). Troponin levels were categorized as normal (0.00-0.05 ng/mL), mildly elevated (0.05-1 ng/mL), and significantly elevated (>1 ng/mL). ECGs were reviewed and interpreted.

Results: The majority of patients (71%) were males aged 41-50. Common COVID-19 symptoms included dyspnea and cough (75%), followed by fever, fatigue, and malaise (80%). Gastrointestinal symptoms were seen in 20%, and 10% experienced anosmia or dysgeusia. Comorbidities included diabetes mellitus (65%), hypertension (60%), CKD (10%), coronary artery diseases (13%), and other cardiovascular diseases (5%). Abnormal LFTs were observed in 30%. Initial troponin levels averaged 0.18 ± 1.75 ng/mL, with a maximum of 2.55 ± 17.90 ng/mL. Mortality occurred in 25% of cases.

Conclusion: Our findings suggest that ECG repolarization abnormalities may serve as markers of clinical severity, even in cases with mildly elevated troponin values in COVID-19 patients.

Keywords: covid-19, electrographic abnormalities, troponin.

References

  1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497-506.
  2. Coronavirus disease (COVID-19) pandemic. Geneva: World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019
  3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395: 1054-1062.
  4. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang X, Lu Z. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020March 27. https://doi.org/10.1001/jamacardio.2020.1017
  5. Rautaharju PM, Kooperberg C, Larson JC, LaCroix A. Electrocardiographic predictors of incident congestive heart failure and all-cause mortality in postmenopausal women: the Women’s Health Initiative. Circulation. 2006; 113: 481-489.
  6. Daviglus ML, Liao Y, Greenland P, Dyer AR, Liu K, Xie X, Huang CF, Prineas RJ, Stamler J. Association of nonspecific minor ST-T abnormalities with cardiovascular mortality: the Chicago Western Electric Study. JAMA. 1999; 282: 530-536.
  7. Park KC, Gaze DC, Collinson PO, Marber MS. Cardiac troponins: from myocardial infarction to chronic disease. Cardiovasc Res. 2017; 113: 1708-1718. 13
  8. Chorin, E., Dai, M., Kogan, E., Wadhwani, L., Shulman, E., Nadeau-Routhier, C., ... & Jankelson, L. (2020). Electrocardiographic Abnormalities and Troponin Elevation in COVID-19. medRxiv.
  9. Clerkin KJ, Fried JA, Raikhelkar J, et al. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease. Circulation. 2020; 18.
  10. Patel AB, Verma A. COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What Is the Evidence?JAMA. 2020; 19.
  11. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiology. 2020.
  12. Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart. 2006; 92(7): 987-993. https://doi.org/10.1136/hrt.2005.071282.

Corresponding Author

Dr. Syeda Masuma Kawsar

MBBS, MD (Cardiology), Consultant Cardiologist, New Labaid Hospital, Brahmanbaria, Bangladesh