Infectious Disease

Comorbidities can explain myocardial abnormalities seen in patients with COVID-19

October 25, 2021

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The authors do not report any relevant financial information.

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Compared to volunteers with associated comorbidity, patients who recovered from severe COVID-19 showed no evidence of left ventricular dysfunction or severe excess of persistent myocardial injury, the researchers reported.

The results indicated that a high prevalence of cardiovascular comorbidities may explain a large part of the reported myocardial abnormalities on cardiac MRI.

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“However, some patients who recovered from COVID-19 had evidence of mild persistent right ventricular dysfunction.” Trisha Singh, BM, Clinical Research Fellow at the University of Edinburgh, Scotland, and colleagues wrote.

In the prospective observational study with two centers Singh and colleagues sought to better understand the contribution of comorbidities to the reported widespread myocardial abnormalities in patients with recent COVID-19.

The study included patients hospitalized with confirmed COVID-19 who received gadolinium and manganese enhanced MRI and coronary CTA. After the masked analysis, the researchers compared these patients to healthy volunteers who were matched for the comorbidity.

The results found that of the 52 patients (median age 54 years; 25% women) who recovered from COVID-19, 29% were admitted to the intensive care unit and 21% were ventilated. In addition, 35% of the 23 patients who underwent coronary CTA had an underlying CAD.

The results showed that patients with COVID-19 had a reduction in LV ejection fraction (57.4% vs. 66.3%; P = 0.02) and right ventricular EF (P = 0.02) compared to younger healthy volunteers (n = 10) 51.7% vs. 60.5%; P .0001). Patients with COVID-19 also showed elevated native T1 values ​​(1,225 ms vs. 1,197 ms; P = 0.04) and extracellular volume fraction (31% vs. 24%; P <0.0003), while myocardial manganese uptake was reduced (6.9.). ml / 100 g / min vs. 7.9 ml / 100 g / min; P = 0.01).

Compared to volunteers with corresponding comorbidities (n = 26), patients with COVID-19 showed preserved LV function but decreased systolic RV function (51.7% vs. 59.3%; p = 0.0005). The researchers also reported similar native T1 values ​​(1,225 vs. 1,227 ms; P = 0.99), extracellular volume (31% vs. 29%; P = 0.35), late presence of gadolinium, and manganese uptake between the two Groups.

Singh and colleagues found that the results were independent of the severity of COVID-19 illness, the presence of a myocardial injury, or the persistent symptoms.

“Concomitant comorbidities and risk factors play an important role in previous reports of left ventricular abnormalities associated with COVID-19,” the researchers wrote. “There was evidence of persistent right ventricular dysfunction in patients recovering from severe COVID-19, which is believed to reflect recent severe viral pneumonia and the resulting pulmonary hypertension.”

They added that future research is needed to “determine the true extent of cardiac abnormalities in patients who have suffered severe COVID-19 and whether this is likely to affect their long-term clinical outcome”.

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