18 Impact of age and sex on myocardial involvement in hospitalized COVID-19 patients. A Pre-specified Subanalysis of COVID-HEART

<h3>Introduction</h3> COVID-HEART was a prospective, longitudinal, multicenter, observational cohort study of patients hospitalized with COVID-19 and elevated serum troponin in the United Kingdom. From a pre-specified subanalysis, we evaluated and compared the interaction of age and sex with CMR abnormalities in COVID-19 inpatients and contemporary controls. <h3>Materials and Methods</h3> Patients recruited to COVID-HEART and contemporary controls were included and divided in three groups (COVID-19 positive, troponin positive inpatients; COVID-19 positive inpatients with non-elevated serum troponin; and non-hospitalized, age and sex-matched controls). The impact of age and sex on cardiac abnormalities (left and right ventricular systolic function, pericardial effusion, and myocardial scarring) and myocardial inflammation on CMR was assessed in linear or logistic regression models, and odds ratios (OR) with 95% confidence intervals along with the corresponding p-values for interaction reported. <h3>Results</h3> Of 519 individuals in COVID-HEART (n=342 cases and n=177 controls), 163 (31.4%) were females, of which 99 (60.7%) were hospitalized with COVID-19 and elevated serum troponin. Median age (IQR) was 61 (54–69) years. CMR abnormalities were not dependent on patient age (p-<i>interaction</i> = 0.5) and were more frequent in males (72% vs 60%, p-<i>interaction</i> &lt; 0.001. Overall, a higher prevalence of macroscopic infarction was observed in males (16% in males vs 5.3% in females, p-<i>interaction</i> = 0.002). Comparable proportions of males and females had microinfarction (9.2%), non-ischemic scar (12.0%), or dual pathology (2.5%) patterns. The microinfarct pattern was exclusively identified among hospitalized patients irrespective of age and sex. No differences in the proportion of patients with LV systolic impairment or pericardial effusion were identified. Females had significantly higher myocardial inflammation detected by global T2 values (Z-score 0.56 vs -0.07, p &lt; 0.0001), while no age-related differences were detected in global T1 or T2 values. At clinical follow-up, no differences were observed in major adverse cardiovascular event rates between males (15.0%) and females (9.1%, p-<i>interaction</i> = 0.3). <h3>Conclusion</h3> COVID-19 affected the heart differently in males and females, with no major differences noted attributable to age. A greater proportion of male patients was found to have an ischemic scar during the acute infection, while microinfarction and other scar patterns were similarly prevalent between sexes. <h3>Acknowledgements</h3> None

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Published
2024-11-01
DOI
https://doi.org/10.1136/heartjnl-2024-bscmr-19.12
Primary Topic
Cardiovascular Disease and Adiposity
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article
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article

18 Impact of age and sex on myocardial involvement in hospitalized COVID-19 patients. A Pre-specified Subanalysis of COVID-HEART

Fabrizio Ricci, Colin Berry, Adam K McDiarmid, Dana Dawson et al.
Cardiovascular Disease and Adiposity
article

18 Impact of age and sex on myocardial involvement in hospitalized COVID-19 patients. A Pre-specified Subanalysis of COVID-HEART

Fabrizio Ricci, Colin Berry, Adam K McDiarmid, Dana Dawson, John Pierre Greenwood, Eylem Levelt, Hunain Shiwani, Gerry P McCann, Vanessa M. Ferreira, Chris Miller, Thomas A. Treibel, Amedeo Chiribiri, Peter Swoboda, Robert Sykes, Charlotte Manisty, Marianna Fontana, Kenneth Mangion, Andrew Lin, Andrew Morrow, Marc R. Dweck, Rhodri Davies, Miroslawa Gorecka, Trisha Singh, Mohammed Alzahir, Stefan Neubauer, Jessica Artico, Stefan K. Piechnik, Alex McConnachie, Robin Young, Elena Lukaschuk, Mayooran Shanmuganathan, Chiara Bucciarelli‐Ducci, Giandomenico Bisaccia, Jayanth R. Arnold, James C Moon, Giles Roditi, Sara Ramírez
article en

Abstract

<h3>Introduction</h3> COVID-HEART was a prospective, longitudinal, multicenter, observational cohort study of patients hospitalized with COVID-19 and elevated serum troponin in the United Kingdom. From a pre-specified subanalysis, we evaluated and compared the interaction of age and sex with CMR abnormalities in COVID-19 inpatients and contemporary controls. <h3>Materials and Methods</h3> Patients recruited to COVID-HEART and contemporary controls were included and divided in three groups (COVID-19 positive, troponin positive inpatients; COVID-19 positive inpatients with non-elevated serum troponin; and non-hospitalized, age and sex-matched controls). The impact of age and sex on cardiac abnormalities (left and right ventricular systolic function, pericardial effusion, and myocardial scarring) and myocardial inflammation on CMR was assessed in linear or logistic regression models, and odds ratios (OR) with 95% confidence intervals along with the corresponding p-values for interaction reported. <h3>Results</h3> Of 519 individuals in COVID-HEART (n=342 cases and n=177 controls), 163 (31.4%) were females, of which 99 (60.7%) were hospitalized with COVID-19 and elevated serum troponin. Median age (IQR) was 61 (54–69) years. CMR abnormalities were not dependent on patient age (p-<i>interaction</i> = 0.5) and were more frequent in males (72% vs 60%, p-<i>interaction</i> &lt; 0.001. Overall, a higher prevalence of macroscopic infarction was observed in males (16% in males vs 5.3% in females, p-<i>interaction</i> = 0.002). Comparable proportions of males and females had microinfarction (9.2%), non-ischemic scar (12.0%), or dual pathology (2.5%) patterns. The microinfarct pattern was exclusively identified among hospitalized patients irrespective of age and sex. No differences in the proportion of patients with LV systolic impairment or pericardial effusion were identified. Females had significantly higher myocardial inflammation detected by global T2 values (Z-score 0.56 vs -0.07, p &lt; 0.0001), while no age-related differences were detected in global T1 or T2 values. At clinical follow-up, no differences were observed in major adverse cardiovascular event rates between males (15.0%) and females (9.1%, p-<i>interaction</i> = 0.3). <h3>Conclusion</h3> COVID-19 affected the heart differently in males and females, with no major differences noted attributable to age. A greater proportion of male patients was found to have an ischemic scar during the acute infection, while microinfarction and other scar patterns were similarly prevalent between sexes. <h3>Acknowledgements</h3> None

University of Leeds (GB), Baker Heart and Diabetes Institute (AU), University of Leicester (GB), University of Aberdeen (GB), Aberdeen Royal Infirmary (GB), University Hospitals Bristol NHS Foundation Trust (GB), The Royal Free Hospital (GB), Newcastle upon Tyne Hospitals NHS Foundation Trust (GB), Glenfield Hospital (GB), Harefield Hospital (GB), University of Manchester (GB), British Heart Foundation (GB), University of Chieti-Pescara (IT), University of Oxford (GB), British Heart Foundation Centre for Cardiovascular Science (GB), St. Thomas Hospital (CA), NIHR Bristol Cardiovascular Biomedical Research Unit (GB), NIHR Leicester Biomedical Research Centre (GB), University College London (GB), Monash University (AU), University of Glasgow (GB), University of Edinburgh (GB)
National Institute for Health and Care Research, British Heart Foundation, University of Leicester, King's College London, University College London, University of Oxford, University of Leeds, University of Glasgow, University of Aberdeen, Università degli Studi G. d'Annunzio Chieti - Pescara, NIHR Leicester Biomedical Research Centre
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