Infectious Disease

Myocardial harm widespread in sufferers with extreme COVID-19 months after discharge

February 18, 2021

2 min read

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The authors do not report any relevant financial information.

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Using cardiac MRI, the researchers found a myocardial injury in more than half of the patients who were hospitalized a few months after hospital discharge with severe COVID-19 and elevated troponin.

“We found evidence of high rates of heart muscle injury showing on the scans a month or two after discharge. While some of these may already have been there, the MRI scan shows some were new and likely caused by COVID-19. ” Marianna Fontana, MD, PhD, Professor of cardiology at University College London, said in a press release. “What is important is that the pattern of heart damage was different, suggesting that the heart is at risk for different types of injury. While we saw only a small amount of persistent injury, we saw an injury to the heart that was present even when the heart’s pumping function was unaffected and may not have been detected by other techniques. In the most severe cases, there is concern that this injury could increase the risk of heart failure in the future, but more work is needed to investigate further. “

Using cardiac MRI, the researchers found a myocardial injury in more than half of the patients who were hospitalized a few months after hospital discharge with severe COVID-19 and elevated troponin.

For this analysis, the researchers included 148 patients from six hospitals (mean age 64 years; 70% men) with severe COVID-19 infection and elevated troponin levels, all of whom required hospitalization (32% who require mechanical ventilation) and were recovering – Heart MRIs subjected to adenosine stress perfusion a median 68 days after discharge.

“Elevated troponin levels are associated with poorer outcomes in COVID-19 patients. Patients with severe COVID-19 disease often have pre-existing heart-related health problems, including diabetes, high blood pressure and obesity, “Fontana said in the press release. “During a severe COVID-19 infection, however, the heart can also be directly affected. It is difficult to unpack how the heart can be damaged, but MRIs of the heart can identify different patterns of injury that allow us to make more accurate diagnoses and more effectively target treatments. “

Myocardial Injury in COVID-19

Patients with abnormal troponin levels were offered cardiac MRI upon discharge and compared to a control group of patients without COVID-19 and 40 healthy volunteers.

The researchers observed that left ventricular function was normal in 89% of the total cohort (mean ejection fraction 67%).

Late gadolinium augmentation and / or ischemia was noted in 54% of participants hospitalized for severe COVID-19 infection. These included a myocarditis-like scar in 26%, MI and / or ischemia in 22%, and dual pathology in 6%.

According to the study, myocarditis-like injury was limited to three or fewer myocardial segments in 88% of patients with no LV dysfunction, of whom 30% had active myocarditis.

In addition, MI was observed in 19% and inducible ischemia was observed in 26% of patients who underwent stress perfusion after discharge.

In addition, 66% of patients with ischemic injury had no history of coronary disease.

The researchers found no evidence of diffuse fibrosis or edema in the distant myocardium.

Two new options

“These results give us two options,” Fontana said in the press release. “First, blood clotting may play a role, which we have potential treatments for, ways to prevent the injury in the first place, and some of the patterns we’ve seen. Second, identifying the consequences of injury during recovery can identify individuals who would benefit from specific supportive drug treatments to protect heart function over time. “

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