tetano
Editor, Senior Moderator
Circulation
. 2023 Jan 27;364-374.
doi: 10.1161/CIRCULATIONAHA.122.060632. Online ahead of print.
Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study
Jessica Artico[SUP] #[/SUP][SUP] 1 [/SUP], Hunain Shiwani[SUP] #[/SUP][SUP] 1 [/SUP], James C Moon[SUP] #[/SUP][SUP] 1 [/SUP], Miroslawa Gorecka[SUP] 2 [/SUP], Gerry P McCann[SUP] 3 [/SUP], Giles Roditi[SUP] 4 [/SUP], Andrew Morrow[SUP] 4 [/SUP], Kenneth Mangion[SUP] 4 [/SUP], Elena Lukaschuk[SUP] 5 [/SUP], Mayooran Shanmuganathan[SUP] 5 [/SUP], Christopher A Miller[SUP] 6 [/SUP], Amedeo Chiribiri[SUP] 7 [/SUP], Sanjay K Prasad[SUP] 8 [/SUP], Robert D Adam[SUP] 1 [/SUP], Trisha Singh[SUP] 9 [/SUP], Chiara Bucciarelli-Ducci[SUP] 4 7 10 11 [/SUP], Dana Dawson[SUP] 12 [/SUP], Daniel Knight[SUP] 13 [/SUP], Marianna Fontana[SUP] 13 [/SUP], Charlotte Manisty[SUP] 1 [/SUP], Thomas A Treibel[SUP] 1 [/SUP], Eylem Levelt[SUP] 2 [/SUP], Ranjit Arnold[SUP] 3 [/SUP], Peter W Macfarlane[SUP] 14 [/SUP], Robin Young[SUP] 15 [/SUP], Alex McConnachie[SUP] 15 [/SUP], Stefan Neubauer[SUP] 5 [/SUP], Stefan K Piechnik[SUP] 5 [/SUP], Rhodri H Davies[SUP] 1 [/SUP], Vanessa M Ferreira[SUP] 5 [/SUP], Marc R Dweck[SUP] 9 [/SUP], Colin Berry[SUP] 4 [/SUP]; OxAMI (Oxford Acute Myocardial Infarction Study) Investigators; COVID-HEART Investigators†; John P Greenwood[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation.
Methods: Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin-) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID-/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months.
Results: Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin-] versus 31% [COVID-/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 (P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12-4.57]; P=0.02).
Conclusions: Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction.
Registration: URL: https://www.isrctn.com; Unique identifier: 58667920.
Keywords: COVID-19; cardiovascular diseases; coronavirus; magnetic resonance imaging; myocardial infarction; troponin.
. 2023 Jan 27;364-374.
doi: 10.1161/CIRCULATIONAHA.122.060632. Online ahead of print.
Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study
Jessica Artico[SUP] #[/SUP][SUP] 1 [/SUP], Hunain Shiwani[SUP] #[/SUP][SUP] 1 [/SUP], James C Moon[SUP] #[/SUP][SUP] 1 [/SUP], Miroslawa Gorecka[SUP] 2 [/SUP], Gerry P McCann[SUP] 3 [/SUP], Giles Roditi[SUP] 4 [/SUP], Andrew Morrow[SUP] 4 [/SUP], Kenneth Mangion[SUP] 4 [/SUP], Elena Lukaschuk[SUP] 5 [/SUP], Mayooran Shanmuganathan[SUP] 5 [/SUP], Christopher A Miller[SUP] 6 [/SUP], Amedeo Chiribiri[SUP] 7 [/SUP], Sanjay K Prasad[SUP] 8 [/SUP], Robert D Adam[SUP] 1 [/SUP], Trisha Singh[SUP] 9 [/SUP], Chiara Bucciarelli-Ducci[SUP] 4 7 10 11 [/SUP], Dana Dawson[SUP] 12 [/SUP], Daniel Knight[SUP] 13 [/SUP], Marianna Fontana[SUP] 13 [/SUP], Charlotte Manisty[SUP] 1 [/SUP], Thomas A Treibel[SUP] 1 [/SUP], Eylem Levelt[SUP] 2 [/SUP], Ranjit Arnold[SUP] 3 [/SUP], Peter W Macfarlane[SUP] 14 [/SUP], Robin Young[SUP] 15 [/SUP], Alex McConnachie[SUP] 15 [/SUP], Stefan Neubauer[SUP] 5 [/SUP], Stefan K Piechnik[SUP] 5 [/SUP], Rhodri H Davies[SUP] 1 [/SUP], Vanessa M Ferreira[SUP] 5 [/SUP], Marc R Dweck[SUP] 9 [/SUP], Colin Berry[SUP] 4 [/SUP]; OxAMI (Oxford Acute Myocardial Infarction Study) Investigators; COVID-HEART Investigators†; John P Greenwood[SUP] 2 [/SUP]
Affiliations
- PMID: 36705028
- DOI: 10.1161/CIRCULATIONAHA.122.060632
Abstract
Background: Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation.
Methods: Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin-) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID-/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months.
Results: Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin-] versus 31% [COVID-/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 (P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12-4.57]; P=0.02).
Conclusions: Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction.
Registration: URL: https://www.isrctn.com; Unique identifier: 58667920.
Keywords: COVID-19; cardiovascular diseases; coronavirus; magnetic resonance imaging; myocardial infarction; troponin.