Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

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.

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Journal
The International Journal of Cardiovascular Imaging
Published
2024-12-30
DOI
https://doi.org/10.1007/s10554-024-03304-7
Primary Topic
COVID-19 Clinical Research Studies
Type
article
Field-Weighted Citation Impact
0.00

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article

Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

Colin Berry, Adam K McDiarmid, James Moon, Dana Dawson et al.
The International Journal of Cardiovascular Imaging
COVID-19 Clinical Research Studies
article

Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

Colin Berry, Adam K McDiarmid, James Moon, Dana Dawson, Eylem Levelt, Hunain Shiwani, Trisha Singh, Gerry P McCann, Vanessa M. Ferreira, Chris Miller, Thomas A. Treibel, Amedeo Chiribiri, Peter Swoboda, Robert Sykes, Charlotte Manisty, Marianna Fontana, Jian L Yeo, Kenneth Mangion, Andrew Lin, Andrew Morrow, Charley Ann Budgeon, Marc R. Dweck, Rhodri Davies, Miroslawa Gorecka, Mohammed Alzahir, Stefan Neubauer, Jessica Artico, Stefan K. Piechnik, Alex McConnachie, Robin Young, Mayooran Shanmuganathan, Chiara Bucciarelli‐Ducci, Jayanth R. Arnold, Rachel England, Giles Roditi, Sara Ramírez, Simran Shergill
article en

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.

The International Journal of Cardiovascular ImagingVol. 41(2)
University of Leeds (GB), St Thomas' Hospital (GB), Baker Heart and Diabetes Institute (AU), University of Leicester (GB), The University of Western Australia (AU), King's College London (GB), University of Aberdeen (GB), Guy's and St Thomas' NHS Foundation Trust (GB), Leeds Teaching Hospitals NHS Trust (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), Freeman Hospital (GB), Glenfield Hospital (GB), Harefield Hospital (GB), University of Manchester (GB), British Heart Foundation (GB), University of Oxford (GB), British Heart Foundation Centre for Cardiovascular Science (GB), Oxford BioMedica (United Kingdom) (GB), NIHR Leicester Biomedical Research Centre (GB), University Hospitals Bristol and Weston NHS Foundation Trust (GB), University College London (GB), University of Glasgow (GB), University of Edinburgh (GB)
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
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