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Cardiac pathology 6 months after hospitalization for COVID-19 and association with the acute disease severity.
Am Heart J. 2021 12; 242:61-70.AH

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) may cause myocardial injury and myocarditis, and reports of persistent cardiac pathology after COVID-19 have raised concerns of long-term cardiac consequences. We aimed to assess the presence of abnormal cardiovascular resonance imaging (CMR) findings in patients recovered from moderate-to-severe COVID-19, and its association with markers of disease severity in the acute phase.

METHODS

Fifty-eight (49%) survivors from the prospective COVID MECH study, underwent CMR median 175 [IQR 105-217] days after COVID-19 hospitalization. Abnormal CMR was defined as left ventricular ejection fraction (LVEF) <50% or myocardial scar by late gadolinium enhancement. CMR indices were compared to healthy controls (n = 32), and to circulating biomarkers measured during the index hospitalization.

RESULTS

Abnormal CMR was present in 12 (21%) patients, of whom 3 were classified with major pathology (scar and LVEF <50% or LVEF <40%). There was no difference in the need of mechanical ventilation, length of hospital stay, and vital signs between patients with vs without abnormal CMR after 6 months. Severe acute respiratory syndrome coronavirus 2 viremia and concentrations of inflammatory biomarkers during the index hospitalization were not associated with persistent CMR pathology. Cardiac troponin T and N-terminal pro-B-type natriuretic peptide concentrations on admission, were higher in patients with CMR pathology, but these associations were not significant after adjusting for demographics and established cardiovascular disease.

CONCLUSIONS

CMR pathology 6 months after moderate-to-severe COVID-19 was present in 21% of patients and did not correlate with severity of the disease. Cardiovascular biomarkers during COVID-19 were higher in patients with CMR pathology, but with no significant association after adjusting for confounders.

TRIAL REGISTRATION

COVID MECH Study ClinicalTrials.gov Identifier: NCT04314232.

Links

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Authors+Show Affiliations

Myhre PL
Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Heck SL
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway.
Skranes JB
Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Prebensen C
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
Jonassen CM
Center for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway.
Berge T
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway.
Mecinaj A
Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Melles W
Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway.
Einvik G
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Pulmonology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
Ingul CB
Department of Circulation and Medical Imaging, Norwegian University of Technology and Science, Trondheim, Norway.
Tveit A
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway.
Berdal JE
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
Røsjø H
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway.
Lyngbakken MN
Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Omland T
Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: torbjorn.omland@medisin.uio.no.

MeSH

AdultAgedBiomarkersCOVID-19CicatrixFemaleGadoliniumHeart DiseasesHumansMagnetic Resonance Imaging, CineMaleMiddle AgedNatriuretic Peptide, BrainPeptide FragmentsProspective StudiesSeverity of Illness IndexStroke VolumeSurvivorsTroponin TVentricular Dysfunction, Left

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34400140

Clinical Trial Links

Clinical trial which this article describes

Citation

Myhre, Peder L., et al. "Cardiac Pathology 6 Months After Hospitalization for COVID-19 and Association With the Acute Disease Severity." American Heart Journal, vol. 242, 2021, pp. 61-70.
Myhre PL, Heck SL, Skranes JB, et al. Cardiac pathology 6 months after hospitalization for COVID-19 and association with the acute disease severity. Am Heart J. 2021;242:61-70.
Myhre, P. L., Heck, S. L., Skranes, J. B., Prebensen, C., Jonassen, C. M., Berge, T., Mecinaj, A., Melles, W., Einvik, G., Ingul, C. B., Tveit, A., Berdal, J. E., Røsjø, H., Lyngbakken, M. N., & Omland, T. (2021). Cardiac pathology 6 months after hospitalization for COVID-19 and association with the acute disease severity. American Heart Journal, 242, 61-70. https://doi.org/10.1016/j.ahj.2021.08.001
Myhre PL, et al. Cardiac Pathology 6 Months After Hospitalization for COVID-19 and Association With the Acute Disease Severity. Am Heart J. 2021;242:61-70. PubMed PMID: 34400140.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiac pathology 6 months after hospitalization for COVID-19 and association with the acute disease severity. AU - Myhre,Peder L, AU - Heck,Siri L, AU - Skranes,Julia B, AU - Prebensen,Christian, AU - Jonassen,Christine M, AU - Berge,Trygve, AU - Mecinaj,Albulena, AU - Melles,Woldegabriel, AU - Einvik,Gunnar, AU - Ingul,Charlotte B, AU - Tveit,Arnljot, AU - Berdal,Jan Erik, AU - Røsjø,Helge, AU - Lyngbakken,Magnus N, AU - Omland,Torbjørn, Y1 - 2021/08/13/ PY - 2021/04/18/received PY - 2021/08/02/accepted PY - 2021/8/18/pubmed PY - 2021/11/12/medline PY - 2021/8/17/entrez KW - CMR KW - COVID-19 KW - NT-proBNP KW - biomarkers KW - cardiac magnetic resonance imaging KW - troponin SP - 61 EP - 70 JF - American heart journal JO - Am Heart J VL - 242 N2 - BACKGROUND: Coronavirus disease 2019 (COVID-19) may cause myocardial injury and myocarditis, and reports of persistent cardiac pathology after COVID-19 have raised concerns of long-term cardiac consequences. We aimed to assess the presence of abnormal cardiovascular resonance imaging (CMR) findings in patients recovered from moderate-to-severe COVID-19, and its association with markers of disease severity in the acute phase. METHODS: Fifty-eight (49%) survivors from the prospective COVID MECH study, underwent CMR median 175 [IQR 105-217] days after COVID-19 hospitalization. Abnormal CMR was defined as left ventricular ejection fraction (LVEF) <50% or myocardial scar by late gadolinium enhancement. CMR indices were compared to healthy controls (n = 32), and to circulating biomarkers measured during the index hospitalization. RESULTS: Abnormal CMR was present in 12 (21%) patients, of whom 3 were classified with major pathology (scar and LVEF <50% or LVEF <40%). There was no difference in the need of mechanical ventilation, length of hospital stay, and vital signs between patients with vs without abnormal CMR after 6 months. Severe acute respiratory syndrome coronavirus 2 viremia and concentrations of inflammatory biomarkers during the index hospitalization were not associated with persistent CMR pathology. Cardiac troponin T and N-terminal pro-B-type natriuretic peptide concentrations on admission, were higher in patients with CMR pathology, but these associations were not significant after adjusting for demographics and established cardiovascular disease. CONCLUSIONS: CMR pathology 6 months after moderate-to-severe COVID-19 was present in 21% of patients and did not correlate with severity of the disease. Cardiovascular biomarkers during COVID-19 were higher in patients with CMR pathology, but with no significant association after adjusting for confounders. TRIAL REGISTRATION: COVID MECH Study ClinicalTrials.gov Identifier: NCT04314232. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/34400140/Cardiac_pathology_6_months_after_hospitalization_for_COVID_19_and_association_with_the_acute_disease_severity_ DB - PRIME DP - Unbound Medicine ER -