265 Incidence, determinants and prognostic relevance of HS-troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

Abstract

Aims: myocardial involvement in the course of Coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. Aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods and results: in this multicenter observational study, we analyzed data from n ¼ 111 COVID-19 patients admitted to dedicated "COVID-19" medical units. Hs-Troponin was assessed in n ¼ 103 patients and NP in n ¼ 82 patients on admission; subgroups were identified according to values beyond reference range. increased hs-Troponin and NP were found in 38% and 56% of the cases respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n ¼ 24) showed significantly reduced left ventricu-lar ejection fraction in patients with elevated NP only (p ¼ 0.02), whereas right ven-tricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p ¼ 0.022 and p ¼ 0.03 respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B ¼ 0.419, p ¼ 0.001; B¼-0.212, p ¼ 0.013 and B ¼ 0.179, p ¼ 0.037 respectively), and of NP with age and previous CVD (B ¼ 0.480, p < 0.001 and B ¼ 0.253, p ¼ 0.001 respectively). In patients with in-hospital mortality (n ¼ 23, 21%) hs-Troponin and NP were both higher (p ¼ 0.001 and p ¼ 0.002 respectively), while increasing hs-troponin and NP were associated with worse in-hospital prognosis [OR 4.88 (95% CI 1.9-12.2), p ¼ 0.001 (adjusted OR 3.1 (95% CI 1.2-8.5), p ¼ 0.025) and OR 4.67 (95% CI 2-10.8), p < 0.001 (adjusted OR 2.89 (95% CI 1.1-7.9), p ¼ 0.04) respectively]. Receiver operator characteristic curves showed good ability of hs-Troponin and NP in predicting in-hospital mortality (AUC ¼ 0.869 p < 0.001 and AUC ¼ 0.810, p < 0.001 respectively). Conclusion: myocardial involvement at admission is common in COVID-19 pneumonia and associated to worse prognosis, suggesting a role for cardiac biomarkers assessment in COVID-19 risk stratification. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point towards existing different mechanisms leading to their elevation in this setting. 235 Percutaneous urgent treatment of severe aortic stenosis in a patient during SARS-CoV-2 pandemic: role of balloon aortic valvuloplasty Aims: The majority of transcatheter aortic valve implantation (TAVI) procedures are performed on an elective basis and, therefore, have been postponed during Coronavirus disease 2019 (COVID-19) outbreak. However, delay in the treatment of severe aortic stenosis (AS) may increase the risk of adverse events, particularly in elderly patients with multiple comorbidities. Methods and results: An 86-year-old man, affected by severe AS was referred to our Institution from a spoke centre due to decompensated heart failure refractory to optimal medical therapy. Three months before, the patient was evaluated by our Heart Team and was scheduled for TAVI. Since that time, he had been waiting for elective TAVI procedure, which was postponed due to the COVID-19 outbreak spark. Due to the clinical and computed tomography suspicion of SARS-CoV-2 infection he underwent nasopharyngeal swab and was temporarily isolated. However, the rapid deterioration of clinical and hemodynamic conditions required emergency treatment. We performed a balloon aortic valvuloplasty (BAV) as a bridge for TAVI, and achieved a reduction of the invasive transaortic gradient from 43 to 10 mmHg after one inflation. The patient's clinical and hemodynamic conditions markedly improved within a few hours; the next day, the result of the reverse-tras-criptase polymer chain reaction for COVID-19 was negative. At day five, he underwent TAVI procedure with implantation of a CoreValve Evolut TM Pro 29. Subsequent clinical course was uneventful. Conclusion: In the context of COVID-19 pandemic, the deferral of TAVI procedure should be assessed on a case-by-case basis in order to avoid delay in patients at high risk for adverse events. BAV may be an option in heart failure patients with severe AS when TAVI is temporarily contraindicated such as in patients suspected for COVID-19. Aims: Conflicting results are available regarding the influence of ACEi/ARBs on the risk of COVID-19 infection, while less is known about their impact on clinical outcome of STEMI patients with confirmed diagnosis of COVID-19. Our aim was to evaluate the impact of ACEi/ARBs therapy on in-hospital mortality and clinical outcomes of STEMI patients during COVID-19 pandemic. Methods and results: We retrospectively analysed consecutive STEMI patients hospi-talised from February 20, to May 10, 2020 at four Hospitals in Lombardy. SARS-COV-2 diagnosis was performed by nasopharingeal swab test. Procedural outcome, respiratory complications and in-hospital mortality were reported. Univariate and multivari-ate analysis were performed by logistic regressions. Our population was represented by 182 STEMI patients, 76.9% male, mean age 67þ/-12.5. Hypertension was reported in 53.3%, treated with ACEi/ARBs in 29.1%. COVID-19 diagnosis was confirmed in 17.1%. In-hospital mortality (13.2%) was significantly higher in COVID-19 patients (31% vs 10%, p ¼ 0.003), even if ejection fraction (OR 0.93[95%CI]0.87-0.99; p ¼ 0.03) and respiratory complications (OR 9.39[95%CI]1.91-45.9; p ¼ 0.006) result the only two independent predictors. The incidence of COVID-19 infection was not influenced by ACEi/ARBs (16.5% in naı¨venaı¨ve vs 18.8%) whose presence at admission did not correlate with respiratory complications or mortality both in case of discontinuation or manteinance. Conclusion: In a high-risk population, such as that of STEMIs, the potential benefit of ACEi/ARBs discontinuation in COVID-19 patients is overcome by its detrimental effect. Intensive care, additional preventive respiratory investigations, regardless from swab test result, should be suggested among all patients admitted for STEMI during pandemic.