{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T14:36:32Z","timestamp":1793284592993,"version":"4.5.0"},"reference-count":40,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","heartandlung.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Heart & Lung"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1016\/j.hrtlng.2026.102945","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T03:56:19Z","timestamp":1789530979000},"page":"102945","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Troponin elevation reflects disease severity rather than cardiac injury or dysfunction in mechanically ventilated COVID-19 ARDS patients"],"prefix":"10.1016","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4444-0967","authenticated-orcid":false,"given":"Georgios E.","family":"Zakynthinos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Tzima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Xanthopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Oikonomou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Papamichalis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achilleas","family":"Chovas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Plageras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias E.","family":"Dimeas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios \u0399.","family":"Tsironikos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Kalogeras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Siasos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grigorios","family":"Giamouzis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Tsolaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"7","key":"10.1016\/j.hrtlng.2026.102945_bib0001","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1001\/jamacardio.2020.0950","article-title":"Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China","volume":"5","author":"Shi","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"1","key":"10.1016\/j.hrtlng.2026.102945_bib0002","first-page":"6","article-title":"The peak levels of highly sensitive troponin I predicts in-hospital mortality in COVID-19 patients with cardiac injury: a retrospective study","volume":"10","author":"Wang","year":"2021","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"issue":"6","key":"10.1016\/j.hrtlng.2026.102945_bib0003","doi-asserted-by":"crossref","DOI":"10.1111\/eci.13532","article-title":"Cardiac troponin and COVID-19 severity: results from BIOCOVID study","volume":"51","author":"Garcia de Guadiana-Romualdo","year":"2021","journal-title":"Eur J Clin Invest"},{"issue":"7","key":"10.1016\/j.hrtlng.2026.102945_bib0004","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1001\/jamacardio.2020.1017","article-title":"Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19)","volume":"5","author":"Guo","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"5","key":"10.1016\/j.hrtlng.2026.102945_bib0005","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jacc.2020.06.007","article-title":"Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection","volume":"76","author":"Lala","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"11","key":"10.1016\/j.hrtlng.2026.102945_bib0006","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1093\/eurheartj\/ehab696","article-title":"Task Force for the management of C-otESoC. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis","volume":"43","year":"2022","journal-title":"Eur Heart J"},{"issue":"20","key":"10.1016\/j.hrtlng.2026.102945_bib0007","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1161\/CIRCULATIONAHA.120.046941","article-title":"COVID-19 and cardiovascular disease","volume":"141","author":"Clerkin","year":"2020","journal-title":"Circulation"},{"issue":"39","key":"10.1016\/j.hrtlng.2026.102945_bib0008","doi-asserted-by":"crossref","first-page":"3827","DOI":"10.1093\/eurheartj\/ehaa664","article-title":"Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study","volume":"41","author":"Basso","year":"2020","journal-title":"Eur Heart J"},{"issue":"10234","key":"10.1016\/j.hrtlng.2026.102945_bib0009","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"},{"issue":"9","key":"10.1016\/j.hrtlng.2026.102945_bib0010","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1093\/ehjci\/jeaa178","article-title":"Global evaluation of echocardiography in patients with COVID-19","volume":"21","author":"Dweck","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"1","key":"10.1016\/j.hrtlng.2026.102945_bib0011","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13613-024-01241-1","article-title":"Comprehensive temporal analysis of right ventricular function and pulmonary haemodynamics in mechanically ventilated COVID-19 ARDS patients","volume":"14","author":"Tsolaki","year":"2024","journal-title":"Ann Intensive Care"},{"issue":"3","key":"10.1016\/j.hrtlng.2026.102945_bib0012","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s15010-020-01572-8","article-title":"Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury","volume":"49","author":"Bieber","year":"2021","journal-title":"Infection"},{"issue":"1","key":"10.1016\/j.hrtlng.2026.102945_bib0013","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s13613-022-01030-8","article-title":"Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients","volume":"12","author":"Jansson","year":"2022","journal-title":"Ann Intensive Care"},{"issue":"6","key":"10.1016\/j.hrtlng.2026.102945_bib0014","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s00134-022-06685-2","article-title":"Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)","volume":"48","author":"Huang","year":"2022","journal-title":"Intensive Care Med"},{"key":"10.1016\/j.hrtlng.2026.102945_bib0015","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.5114\/amsad\/209039","article-title":"Correlation of acute myocardial injury and long-term cardiac function in COVID-19 survivors with acute myocarditis","volume":"10","author":"Maragkoudakis","year":"2025","journal-title":"Arch Med Sci Atheroscler Dis"},{"issue":"1","key":"10.1016\/j.hrtlng.2026.102945_bib0016","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1186\/s12872-025-04971-7","article-title":"Assessment of cardiac dysfunction in COVID-19 patients using layer-specific strain echocardiography in short-axis and long-axis views","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Cardiovasc Disord"},{"issue":"1","key":"10.1016\/j.hrtlng.2026.102945_bib0017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00134-020-06262-5","article-title":"The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies","volume":"47","author":"Sanfilippo","year":"2021","journal-title":"Intensive Care Med"},{"issue":"3","key":"10.1016\/j.hrtlng.2026.102945_bib0018","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"8","key":"10.1016\/j.hrtlng.2026.102945_bib0019","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1093\/ehjci\/jex140","article-title":"Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study","volume":"18","author":"Sugimoto","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"3","key":"10.1016\/j.hrtlng.2026.102945_bib0020","doi-asserted-by":"crossref","first-page":"R94","DOI":"10.1186\/cc13864","article-title":"New insights into the mechanisms involved in B-type natriuretic peptide elevation and its prognostic value in septic patients","volume":"18","author":"Papanikolaou","year":"2014","journal-title":"Crit Care"},{"issue":"10","key":"10.1016\/j.hrtlng.2026.102945_bib0021","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.jacc.2020.06.068","article-title":"Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week","volume":"76","author":"Sandoval","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"10.1016\/j.hrtlng.2026.102945_bib0022","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1161\/CIRCULATIONAHA.120.050543","article-title":"Myocardial injury in severe COVID-19 compared with non-COVID-19 acute respiratory distress syndrome","volume":"143","author":"Metkus","year":"2021","journal-title":"Circulation"},{"issue":"11","key":"10.1016\/j.hrtlng.2026.102945_bib0023","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1016\/S0735-1097(03)00421-2","article-title":"Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes","volume":"41","author":"Ammann","year":"2003","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"10.1016\/j.hrtlng.2026.102945_bib0024","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1007\/s00134-013-3045-2","article-title":"Acute cor pulmonale in ARDS","volume":"39","author":"Vieillard-Baron","year":"2013","journal-title":"Intensive Care Med"},{"issue":"5","key":"10.1016\/j.hrtlng.2026.102945_bib0025","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1007\/s00134-015-4141-2","article-title":"Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact","volume":"42","author":"Mekontso Dessap","year":"2016","journal-title":"Intensive Care Med"},{"issue":"2","key":"10.1016\/j.hrtlng.2026.102945_bib0026","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1086\/685549","article-title":"Echocardiographic parameters of right ventricular function predict mortality in acute respiratory distress syndrome: a pilot study","volume":"6","author":"Shah","year":"2016","journal-title":"Pulm Circ"},{"issue":"12","key":"10.1016\/j.hrtlng.2026.102945_bib0027","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1111\/echo.13350","article-title":"Early detection of right ventricular dysfunction using transthoracic echocardiography in ARDS: a more objective approach","volume":"33","author":"Wadia","year":"2016","journal-title":"Echocardiography"},{"issue":"6","key":"10.1016\/j.hrtlng.2026.102945_bib0028","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00134-022-06730-0","article-title":"Right ventricular failure is strongly associated with mortality in patients with moderate-to-severe COVID-19-related ARDS and appears related to respiratory worsening","volume":"48","author":"Evrard","year":"2022","journal-title":"Intensive Care Med"},{"issue":"2","key":"10.1016\/j.hrtlng.2026.102945_bib0029","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1164\/rccm.202301-0154LE","article-title":"Positive end-expiratory pressure deescalation in COVID-19-induced acute respiratory distress syndrome unloads the right ventricle, improving hemodynamics and oxygenation","volume":"208","author":"Tsolaki","year":"2023","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"10.1016\/j.hrtlng.2026.102945_bib0030","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1186\/s13054-020-03385-5","article-title":"Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS","volume":"24","author":"D'Alto","year":"2020","journal-title":"Crit Care"},{"issue":"4","key":"10.1016\/j.hrtlng.2026.102945_bib0031","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.023220","article-title":"Impact of right ventricular-pulmonary circulation coupling on mortality in SARS-CoV-2 infection","volume":"11","author":"Bursi","year":"2022","journal-title":"J Am Heart Assoc"},{"issue":"20","key":"10.1016\/j.hrtlng.2026.102945_bib0032","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"issue":"10","key":"10.1016\/j.hrtlng.2026.102945_bib0033","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1093\/cvr\/cvaa106","article-title":"COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options","volume":"116","author":"Guzik","year":"2020","journal-title":"Cardiovasc Res"},{"issue":"7","key":"10.1016\/j.hrtlng.2026.102945_bib0034","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S2213-2600(20)30243-5","article-title":"Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans","volume":"8","author":"Fox","year":"2020","journal-title":"Lancet Respir Med"},{"issue":"19","key":"10.1016\/j.hrtlng.2026.102945_bib0035","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1093\/eurheartj\/ehaa286","article-title":"Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection","volume":"41","author":"Sala","year":"2020","journal-title":"Eur Heart J"},{"issue":"5","key":"10.1016\/j.hrtlng.2026.102945_bib0036","first-page":"411","article-title":"A pathological report of three COVID-19 cases by minimal invasive autopsies]","volume":"49","author":"Yao","year":"2020","journal-title":"Zhonghua Bing Li Xue Za Zhi"},{"issue":"6","key":"10.1016\/j.hrtlng.2026.102945_bib0037","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1056\/NEJMc2011400","article-title":"Multiorgan and renal tropism of SARS-CoV-2","volume":"383","author":"Puelles","year":"2020","journal-title":"N Engl J Med"},{"issue":"17","key":"10.1016\/j.hrtlng.2026.102945_bib0038","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.jacc.2022.02.003","volume":"79","author":"Writing","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"10.1016\/j.hrtlng.2026.102945_bib0039","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14030986","article-title":"Septic cardiomyopathy: difficult definition, challenging diagnosis, unclear treatment","volume":"14","author":"Zakynthinos","year":"2025","journal-title":"J Clin Med"},{"issue":"1","key":"10.1016\/j.hrtlng.2026.102945_bib0040","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s10554-020-02102-1","article-title":"The relation between left ventricular global longitudinal strain and troponin levels in patients hospitalized with COVID-19 pneumonia","volume":"37","author":"Balaban Kocas","year":"2021","journal-title":"Int J Cardiovasc Imaging"}],"container-title":["Heart & Lung"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0147956326002293?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0147956326002293?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T14:10:00Z","timestamp":1793283000000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0147956326002293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":40,"alternative-id":["S0147956326002293"],"URL":"https:\/\/doi.org\/10.1016\/j.hrtlng.2026.102945","relation":{},"ISSN":["0147-9563"],"issn-type":[{"value":"0147-9563","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Troponin elevation reflects disease severity rather than cardiac injury or dysfunction in mechanically ventilated COVID-19 ARDS patients","name":"articletitle","label":"Article Title"},{"value":"Heart & Lung","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.hrtlng.2026.102945","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"102945"}}