Impact of SARS-CoV-2 infection on subclinical myocardial injury in the general population: the Trøndelag Health Study

AIMS: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with acute increases in cardiac troponin and a higher risk of cardiovascular outcomes, but the interaction between SARS-CoV-2 and chronic subclinical myocardial injury is unclear. Accordingly, we aimed to assess the associations between SARS-CoV-2 infection and chronic subclinical myocardial injury in the general population. METHODS: We measured cardiac troponin I (cTnI) with a high-sensitivity assay in 37 823 persons recruited from the general population participating in the Trøndelag Health Study immediately before (2018 to 2019, pre-pandemic) the COVID-19 pandemic. Of these, the measurement of cTnI and SARS-CoV-2-spike IgG and nucleocapsid IgG was performed in 19 550 persons after (2021-2023, post-pandemic) the COVID-19 pandemic. We assessed the associations of immunological, self-reported, and laboratory-verified SARS-CoV-2 infection with changes in cTnI from pre- to post-pandemic, as well as the association of pre-pandemic cTnI with the risk of incident SARS-CoV-2 infection. RESULTS: Higher pre-pandemic cTnI was associated with a lower risk of contracting SARS-CoV-2. Interim SARS-CoV-2 infection was associated with higher concentrations of post-pandemic cTnI and a higher probability of increasing pre- to post-pandemic concentration of cTnI when adjusting for potential confounders and pre-pandemic cTnI. CONCLUSION: In a large cohort of community dwellers, SARS-CoV-2 is associated with a higher probability of increasing concentrations of cTnI from before to after infection, reinforcing the role of SARS-CoV-2 infection in the development of chronic subclinical myocardial injury. In contrast, pre-existing chronic subclinical myocardial injury was not associated with increased risk of contracting SARS-CoV-2.