Elevated Troponin T Levels May be Indicative of Disease Severity in COVID-19 ARDS

Troponin test, blood sample
Troponin test, blood sample
In patients with COVID-19–related ARDS, increased troponin T levels were found to be common and may be linked to disease severity.

In patients with coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome (ARDS), increased troponin T levels were found to be common and may be linked to disease severity, according to a study published in the American Journal of Cardiology.

In this study, the data of 28 consecutive patients with COVID-19 and ARDS (ages, 61.7±10 years; 79% men) who were admitted to an intensive care unit (ICU) between March 1, 2020 and March 31, 2020 were examined. Cardiac involvement was determined by serial troponin T level assessment, echocardiographic examination, and arrhythmic event monitoring.

Of these 28 patients, 24 (86%) were mechanically ventilated and 4 (14%) required veno-venous extracorporeal membrane oxygenation (ECMO). As of March 31, 2020, the ICU mortality rate was 7%, and 7 patients (25%) were discharged with a length of stay of 8.2 ± 5 days.

Acute core pulmonale was observed in 2 patients who required ECMO support, and all patients had increased systolic arterial pressure. Levels of troponin T were elevated in 11 patients (39%). Troponin T level was found to be directly associated with C-reactive protein (CRP).

In COVID-19–related ARDS, increases in troponin levels were common “but not associated with alterations in wall motion kinesis, thus suggesting that troponin T elevation is likely to be multifactorial, mainly linked to disease sever[ity] (as inferred by the relation between troponin and CRP),” the study authors commented. “The increase in systolic pulmonary arterial pressures observed in all patients may be related to hypoxic vasoconstriction.”

The researchers noted that the small number of patients from a single center may be a limitation, but “our population is homogeneous, including severe COVID-19 ARDS requiring ICU,” they commented.

“[I]n our series, troponin showed a positive direct relationship with CRP values, a marker of inflammatory activation in COVID-19 disease,” noted the investigators. “Furthermore, troponin increase was observed. Further studies should be performed in patients [with severe COVID-19] to assess whether troponin values could help [with] risk stratification, as previously reported in patients with mild COVID-19 disease.”


Lazzeri C, Bonizzoli M, Batacchi S, et al. Cardiac involvement in COVID-19–related acute respiratory distress syndrome [published online July 12, 2020]. Am J Cardiol. https://doi.org/10.1016/j.amjcard.2020.07.010