Clinical Significance of Myocardial Injury in Patients Hospitalized for COVID-19: A Prospective, Multicenter, Cohort
Hunain Shiwani1, Jessica Artico1, James C Moon1
1Institute of Cardiovascular Science, University College London, London, United Kingdom.
Insights
Myocardial injury in severe COVID-19 survivors is nonprogressive, with a low incidence of major adverse cardiovascular events. Quality of life improved significantly over 12 months post-discharge.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Hospitalized COVID-19 patients with troponin elevation often exhibit cardiac abnormalities.
- The long-term impact of myocardial injury on COVID-19 survivors remains incompletely understood.
Purpose of the Study:
- To evaluate myocardial injury progression in COVID-19 survivors with troponin elevation using serial cardiac magnetic resonance (CMR) imaging.
- To assess medium-term cardiovascular outcomes and quality of life in these patients.
Main Methods:
- A prospective, longitudinal cohort study involving 342 hospitalized COVID-19 patients with myocardial injury across 25 UK centers.
- Cardiac magnetic resonance (CMR) scans were performed within 28 days and at 6 months post-discharge.
- Outcomes and quality of life (EuroQol-5 Dimension, SF-36) were tracked for 12 months.
Main Results:
- At 12 months, major adverse cardiovascular events were infrequent (1.2% mortality, 1.8% myocardial infarction/ACS/revascularization).
- Cardiac magnetic resonance (CMR) at 6 months showed stable myocardial scar, no ongoing inflammation, and minor improvements in left ventricular ejection fraction.
- Significant improvements in quality of life scores were reported by 6 months post-discharge.
Conclusions:
- Myocardial injury in severe hospitalized COVID-19 survivors appears nonprogressive.
- Medium-term outcomes are favorable, characterized by a low incidence of major adverse cardiovascular events and enhanced quality of life.
Background:
Hospitalized COVID-19 patients with troponin elevation have a higher prevalence of cardiac abnormalities than control individuals. However, the progression and impact of myocardial injury on COVID-19 survivors remain unclear.
Objectives:
This study sought to evaluate myocardial injury in COVID-19 survivors with troponin elevation with baseline and follow-up imaging and to assess medium-term outcomes.
Methods:
This was a prospective, longitudinal cohort study in 25 United Kingdom centers (June 2020 to March 2021). Hospitalized COVID-19 patients with myocardial injury underwent cardiac magnetic resonance (CMR) scans within 28 days and 6 months postdischarge. Outcomes were tracked for 12 months, with quality of life surveys (EuroQol-5 Dimension and 36-Item Short Form surveys) taken at discharge and 6 months.
Results:
Of 342 participants (median age: 61.3 years; 71.1% male) with baseline CMR, 338 had a 12-month follow-up, 235 had a 6-month CMR, and 215 has baseline and follow-up quality of life surveys. Of 338 participants, within 12 months, 1.2% died; 1.8% had new myocardial infarction, acute coronary syndrome, or coronary revascularization; 0.8% had new myopericarditis; and 3.3% had other cardiovascular events requiring hospitalization. At 6 months, there was a minor improvement in left ventricular ejection fraction (1.8% ± 1.0%; P < 0.001), stable right ventricular ejection fraction (0.4% ± 0.8%; P = 0.50), no change in myocardial scar pattern or volume (P = 0.26), and no imaging evidence of continued myocardial inflammation. All pericardial effusions (26 of 26) resolved, and most pneumonitis resolved (95 of 101). EuroQol-5 Dimension scores indicated an overall improvement in quality of life (P < 0.001).
Conclusions:
Myocardial injury in severe hospitalized COVID-19 survivors is nonprogressive. Medium-term outcomes show a low incidence of major adverse cardiovascular events and improved quality of life. (COVID-19 Effects on the Heart; ISRCTN58667920).
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