HIGHLY SENSITIVE TROPONIN T LEVELS IN PATIENTS WITH HF AND COVID-19

Full Text

CHF is an urgent medical social problem characterized by steady growth over the years[1]. Currently, more than 12 million people in the Russian Federation suffer from CHF. Despite the successes achieved in therapy, the mortality rate from CHF is still high [2]. Patients diagnosed with CHF have steady progress in the course of the disease and are subject to constant hospitalizations, which further leads to persistent disability and loss of working capacity. Also, it is known that the transfer of viral infections often leads to decompensation of CH [3]. Thus, an increase in the levels of cardiac biomarkers during coronavirus infection may reflect direct or indirect myocardial damage.

Objective: To study the level of hs-TnT in patients with chronic heart failure and COVID-19.

Materials and methods: The study included patients aged 40 to 70 years with a diagnosis of CHF of ischemic genesis (including 33 men and 27 women, mean age 63.7±8.1 years) who underwent a full clinical and laboratory examination confirmed by a diagnosis of Covid-19, with a  positive polymerase chain reaction (PCR) smear from the nasopharynx for SARS-C oV infection -2 (n=60). The control group consisted of patients with symptoms and signs associated with Covid-19 and positive polymerase chain reaction (PCR) of a nasopharyngeal swab for SARS-C infection about V-2 patients, without symptoms and signs of HF in the anamnesis (n = 20).  All patients gave verbalvoluntary informed consent to participate in the study.  All clinical procedures and treatment were carried out in accordance with the current recommendations for the treatment of patients with a new coronavirus infection, as well as in accordance with the current recommendations of the Ministry of Health of Russia for the diagnosis and treatment of CHF (2020).

Clinical-instrumental and laboratory examination was performed on all patients included in the study: group 1 (60 patients with CHF and various LV EF during their hospitalization for novel coronavirus infection), group 2 (control group - 20 hospitalized with symptoms and signs associated with Covid-19 and positive polymerase chain reaction (PCR) nasopharyngeal swab for SARS-CoV -2 patients, without symptoms and signs of HF in the anamnesis).

The study did not include patients with bronchopulmonary diseases, chronic kidney disease (stage 3b and above), diabetes mellitus, persistent atrial fibrillation, anemia, diseases of the musculoskeletal system, obesity (2-3 degrees), oncological diseases, with an established diagnosis of chronic pulmonary heart.

All patients with CHF included in the study were observed by us since 2020, and during the entire time of observation of them after discharge from the hospital (hospitalization for Covid-19), they had the opportunity to contact a cardiologist. Within six months, 8 people (6 people with CHF and 2 people with no history of symptoms and signs of HF) dropped out of the study due to the onset of one of the endpoints (death). Laboratory tests were carried out. Laboratory tests were carried out  methods: general clinical and enzyme immunoassays of blood with determination of the level ofi hs-TnT.

Statistical analysis was carried out using the Statistica 12 software package. The normality of the data distribution was assessed using a test (Shapira-Wilke). The initial continuous variables were presented as a standard mean deviation and compared using the Student t-criterion, in the form of a median and interquartile range, and compared using the Mann-Whitney and Kruskal-Wallis tests. Categorical ones were compared using the exact  the Fisher method. Differences between subgroups were considered statistically significant at a significance level of p<0.05.

Results: When conducting research in the first 24 hours from hospitalization, the level of highly sensitive troponin T was determined (Fig. 2). Both in the group of patients with CHF (gr.1) and in the control group (gr.2, without CVD) in more 70% cases patients had elevated levels hs-TnT, which may indicate an acute lesion of cardiomyocytes in most age-related individuals who have undergone Covid-19 Infection.  At examination of patients it was revealed that in a subgroup of patients with CSH (group 1)level hs-TnT was statistically significantly higher 32,48±13,30 Ng/l (5,0;61,0) (p=0.0001) versus gr. 2 (no symptoms or history of CHF) 15,82±5,59 ng/l. Herewith in patients I FC (subgroup 1.1) level of highly sensitive troponin T -  22,13±10,49 ng/L (5.0;35.0) was statically significantly lower than in patients II FC 31,57±12,01 ng/l (5.0;51.0) and III FC 41,46±11,79нG/l (p=0.0001).  

The ratio of the odds of a favorable course of  CHF and Covid-19 or the transfer to the ICU of patients with CHF and Covid-19 depending on the level of hs-TnT (threshold value of ˃30  n g / l) was studied.  The resulting OR was 6.70 [95% CI 2.19606; 20.4702]. Therefore, the probability of non-entry intothe ICU in patients with a level  of hs-TnT below the threshold is 6.7 timeslower than in patients with an hs-TnT level  of ˃30 ng / l.

Also, the ratio of chances of a favorable course of CHF and Covid-19 or death depending on the level of hs-TnT (threshold value ˃ 30 ng / l) was studied.  The resulting OR was 3.40 [95% CI 0.660847; 17.5213]. Therefore, patients with hs-TnT levels below the threshold are 3.4 times lower than patients with hs-TnT ≥30 pg/ml.  It was also noted that normal levels of hs-TnT upon admission were associated with 100% survival rate.

Discussion: Based on the data obtained in the research, it is assumed that hs-TnT biomarker, would play a potential role  in stratifying the risk of severe course/death in patients with  SARS-CoV-2 infection.  There is definitely a relationship between the level of hs-TnT at the time of hospitalization and the prognosis of such patients [4]. When conducting research, it was noted that patients with normal levels of highly sensitive troponin T had a relatively better prognosis (did not reach endpoints, such as transfer to the ICU, death). 

Conclusion: Thresholds for  the cardiac  biomarker (hs-TnT) for stratification and isolation of risk groups among patients with Covid-19, CHF and Covid-19 have been determined. In patients with Covid-19 and CHF, there is a strong association between high levels of hs-TnT and a negative short-term prognosis (ICU transfer/death).

About the authors

Roman E. Tokmachev

Voronezh State Medical University named after N. N. Burdenko

Email: r-tokmachev@mail.ru
ORCID iD: 0000-0001-6379-4635
SPIN-code: 5922-6679
Russian Federation, 10 Studentskaya str., Voronezh, 394036, Russia

Yuliya O. Glavatskikh

Voronezh State Medical University named after N. N. Burdenko

Email: Yuliyag36@gmail.com
ORCID iD: 0000-0002-2398-5987
SPIN-code: 9762-6156
Russian Federation, 10 Studentskaya str., Voronezh, 394036, Russia

Valeria R. Drobysheva

Voronezh State Medical University named after N. N. Burdenko

Email: drobyshevavr@gmail.com
ORCID iD: 0000-0003-0563-5286
SPIN-code: 1262-6060
Russian Federation, 10 Studentskaya str., Voronezh, 394036, Russia

Sofia A. Budnevskaya

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: yuliyag36@gmail.com
ORCID iD: 0000-0001-6636-6644
Russian Federation, 10 Studentskaya str., Voronezh, 394036, Russia

References