Year: 2024
Type: article
Abstract: The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin + , age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID -/comorbidity + , 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.
Authors: J. Ranjit Arnold, Jian L. Yeo, Charley A. Budgeon, Simran Shergill, Rachel England, Hunain Shiwani, Jessica Artico, James C. Moon, Miroslawa Gorecka, Giles Roditi, Andrew Morrow, Kenneth Mangion, Mayooran Shanmuganathan, Christopher A. Miller, Amedeo Chiribiri, Mohammed Alzahir, Sara Ramirez, Andrew Lin, Peter P. Swoboda, Adam K. McDiarmid, Robert Sykes, Trisha Singh, Chiara Bucciarelli-Ducci, Dana Dawson, Marianna Fontana, Charlotte Manisty, Thomas A. Treibel, Eylem Levelt, Robin Young, Alex McConnachie, Stefan Neubauer, Stefan K. Piechnik, Rhodri H. Davies, Vanessa M. Ferreira, Marc R. Dweck, Colin Berry, Oxford Acute Myocardial Infarction OxAMI Study Investigators, COVID-HEART investigators, Gerry P. McCann, John P. Greenwood
Institutions: University of Leicester, Glenfield Hospital, NIHR Leicester Biomedical Research Centre, The University of Western Australia, University College London, University of Leeds, Leeds Teaching Hospitals NHS Trust, University of Glasgow, British Heart Foundation, University of Oxford, University of Manchester, St Thomas' Hospital, King's College London, Guy's and St Thomas' NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Harefield Hospital, Royal Brompton Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, University of Aberdeen, Aberdeen Royal Infirmary, The Royal Free Hospital, Baker Heart and Diabetes Institute
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,390
Funders: Wellcome Trust, UK Research and Innovation, National Institute for Health and Care Research, British Heart Foundation, Department of Health and Social Care, University of Bristol, European Association of Cardiovascular Imaging, Medical Research Council, Engineering and Physical Sciences Research Council, NIHR Oxford Biomedical Research Centre, NIHR Leicester Biomedical Research Centre
Awards: G175695938, G2306515209, What is the best test for the non-invasive diagnosis of significant coronary artery disease?, Myocardial energy starvation and ketone metabolism in patients with type 2 diabetes, G27403434, G3009210321, Myocardial energy starvation and ketone metabolism in patients with type 2 diabetes, Heart failure in type 2 diabetes: improving diagnosis and management in a multi-ethnic population., G3449402819, G3802978584, G407381425, G4445566864, The BHF Field Marshal Earl Alexander Chair of Cardiovascular Medicine, Myocardial fibrosis activity in cardiovascular disease, G573552857, G5918494183, G6535433053, G6929902608, G7272929574, G778364364, Demographic, multi-morbidity and genetic impact on myocardial involvement and its recovery from COVID-19: the COVID-HEART study, Targeting the extracellular matrix to improve the outcome of patients with heart failure, G861349072
OpenAlex ID: W4405884903