Physicians' Academy for Cardiovascular Education

Serial measurements of myocardial injury in mechanically ventilated patients with COVID-19

Serial Assessment of Myocardial Injury Markers in Mechanically Ventilated Patients With SARS-CoV-2 (from the Prospective MaastrICCht Cohort)

Literature - Ghossein MA, Driessen RGH, van Rosmalen F, et al. - Am J Cardiol. 2022;00:1−10.

Introduction and methods


There is a strong association between myocardial injury in COVID-19 and in-hospital mortality [1-3]. However, the development of myocardial injury over time and whether myocardial injury in patients with COVID-19 at the intensive care unit (ICU) is associated with outcome, has not yet been elucidated.

Aim of the study

The objective of this study was to investigate myocardial injury by serial measurements of cardiac biomarkers and serial ECGs over the full course of ICU admission in mechanically ventilated patients with COVID-19, comparing ICU survivors with non-survivors.


This study – which took place between March 25, 2020 to June 23, 2020 – was part of a larger prospective observational study, the Maastricht Intensive Care COVID (MaastrICCht) cohort. A total of 90 patients with respiratory insufficiency who required mechanical ventilation and who had a positive SARS-CoV-2 test and/or chest CT scan strongly suggestive for SARS-CoV-2 infection was included in the final analysis. Of those, 37% were ICU non-survivors and 63% were ICU survivors. Patients were followed up until death in the ICU or discharge from the ICU. High-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were assessed daily and serial ECGs were collected at least every other day.

Main results


Higher hs-cTnT at time of admission and an increase in NT-proBNP over time are strongly associated with mortality in mechanically ventilated patients with COVID-19, irrespective of gender, age, APACHE II score, daily creatinine concentrations and COVID-19 related CV risk factors.


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Find this article online at Am J Cardiol.

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