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CardiOvaScular Mechanisms In Covid-19: methodology of a prospective observational multimodality imaging study
Shirjel R Alam1, Anoop S V Shah2, Kevin O Ombati3
1Manchester University, Manchester, UK.
Insights
Cardiac injury affects 8-28% of COVID-19 patients, impacting prognosis. This study uses advanced cardiac imaging to reveal injury mechanisms and inform clinical decisions during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- COVID-19 infection is linked to cardiac injury in 8-28% of patients, associated with poor outcomes.
- The precise cardiovascular mechanisms driving COVID-19-related cardiac injury remain unclear.
- This research aims to elucidate these mechanisms using advanced imaging techniques.
Purpose of the Study:
- To identify the cardiac pathophysiological mechanisms underlying COVID-19 infection.
- To assess the utility of multimodality cardiac imaging in diagnosing COVID-19-associated cardiac injury.
- To inform clinical decision-making for managing cardiovascular complications in COVID-19 patients.
Main Methods:
- An observational study involving 50 COVID-19 patients.
- Cardiac biomarker sampling, computed tomography coronary angiography (CTCA), 18F-FDG-PET/CT, and cardiac magnetic resonance (CMR) imaging.
- Assessment of coronary artery disease, myocardial disease (dysfunction, fibrosis, edema, infarction), and inflammation.
Main Results:
- The study will determine the presence and characteristics of cardiac injury in COVID-19 patients.
- It will evaluate the effectiveness of multimodality imaging in diagnosing cardiac injury.
- Findings will correlate cardiovascular pathology with troponin levels.
Conclusions:
- The study will clarify the cardiac injury patterns in COVID-19.
- It will highlight the role of multimodality imaging in identifying these injuries.
- Results will aid in better patient management during the pandemic.
Background:
8-28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections.
Methods:
This is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA and 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels.
Discussion:
The results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic.
Trial Registration:
This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at https://www.isrctn.com/ISRCTN12154994.
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