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1.
BMJ Open ; 12(5): e055878, 2022 05 03.
Article in English | MEDLINE | ID: covidwho-1891826

ABSTRACT

BACKGROUND: There are a paucity of randomised data on the optimal timing of invasive coronary angiography (ICA) in higher-risk patients with non-ST elevation myocardial infarction (N-STEMI). International guideline recommendations for early ICA are primarily based on retrospective subgroup analyses of neutral trials. AIMS: The RAPID N-STEMI trial aims to determine whether very early percutaneous revascularisation improves clinical outcomes as compared with a standard of care strategy in higher-risk N-STEMI patients. METHODS AND ANALYSIS: RAPID N-STEMI is a prospective, multicentre, open-label, randomised-controlled, pragmatic strategy trial. Higher-risk N-STEMI patients, as defined by Global Registry of Acute Coronary Events 2.0 score ≥118, or >90 with at least one additional high-risk feature, were randomised to either: very early ICA±revascularisation or standard of care timing of ICA±revascularisation. The primary outcome is the proportion of participants with at least one of the following events (all-cause mortality, non-fatal myocardial infarction and hospital admission for heart failure) at 12 months. Key secondary outcomes include major bleeding and stroke. A hypothesis generating cardiac magnetic resonance (CMR) substudy will provide mechanistic data on infarct size, myocardial salvage and residual ischaemia post percutaneous coronary intervention. On 7 April 2021, the sponsor discontinued enrolment due to the impact of the COVID-19 pandemic and lower than expected event rates. 425 patients were enrolled, and 61 patients underwent CMR. ETHICS AND DISSEMINATION: The trial has been reviewed and approved by the East of England Cambridge East Research Ethics Committee (18/EE/0222). The study results will be submitted for publication within 6 months of completion. TRIAL REGISTRATION NUMBER: NCT03707314; Pre-results.


Subject(s)
COVID-19 , Non-ST Elevated Myocardial Infarction , ST Elevation Myocardial Infarction , Angiography , Humans , Multicenter Studies as Topic , Pandemics , Prospective Studies , Randomized Controlled Trials as Topic , Retrospective Studies , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , Standard of Care
2.
Heart ; 108(Suppl 1):A116, 2022.
Article in English | ProQuest Central | ID: covidwho-1891872

ABSTRACT

150 Table 1Comparison of 31P-MRS and CMR findings between patients with Post-COVID-19 syndrome and healthy volunteersVariable Healthy volunteers (n=10) Post-COVID-19 Syndrome (n=19) p-value PCr/ATP ratio 2.11±0.5 2.24±0.4 0.49 LV end diastolic volume index (ml/m2) 87±20 81±10 0.43 LV ejection fraction (%) 64±4 61±4 0.07 RV end diastolic volume index (ml/m2) 93±23 83±13 0.24 RV ejection fraction (%) 55±8 57±6 0.49 Global longitudinal strain (%) -13.3±2.3 -11.9±3.7 0.21 Mean T1 (ms) 1206±64 1158±114 0.15 Extra-cellular volume (%) 25±2.3 22±4.5 0.03 T2 (ms) 39±2.4 40±2.9 0.46 MPR 3.1±0.9 3.0±0.8 0.89 Continuous variables are expressed as mean (SD) or median (IQR) and categorical variables as number (%). PCr/ATP=phosphocreatine and adenosine triphosphate ratio;LV=left ventricular;ml/m2=milliliters per square meter of body surface area;RV=right ventricular;ms=milliseconds;MPR=myocardial perfusion reserve. 150 Figure 1Evaluation of Cardiac Involvement in Post COVID-19 Syndrome[Figure omitted. See PDF]Conflict of InterestNone

5.
J Cardiovasc Magn Reson ; 23(1): 77, 2021 06 10.
Article in English | MEDLINE | ID: covidwho-1266491

ABSTRACT

BACKGROUND: Although coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, myocardial injury is increasingly reported and associated with adverse outcomes. However, the pathophysiology, extent of myocardial injury and clinical significance remains unclear. METHODS: COVID-HEART is a UK, multicentre, prospective, observational, longitudinal cohort study of patients with confirmed COVID-19 and elevated troponin (sex-specific > 99th centile). Baseline assessment will be whilst recovering in-hospital or recently discharged, and include cardiovascular magnetic resonance (CMR) imaging, quality of life (QoL) assessments, electrocardiogram (ECG), serum biomarkers and genetics. Assessment at 6-months includes repeat CMR, QoL assessments and 6-min walk test (6MWT). The CMR protocol includes cine imaging, T1/T2 mapping, aortic distensibility, late gadolinium enhancement (LGE), and adenosine stress myocardial perfusion imaging in selected patients. The main objectives of the study are to: (1) characterise the extent and nature of myocardial involvement in COVID-19 patients with an elevated troponin, (2) assess how cardiac involvement and clinical outcome associate with recognised risk factors for mortality (age, sex, ethnicity and comorbidities) and genetic factors, (3) evaluate if differences in myocardial recovery at 6 months are dependent on demographics, genetics and comorbidities, (4) understand the impact of recovery status at 6 months on patient-reported QoL and functional capacity. DISCUSSION: COVID-HEART will provide detailed characterisation of cardiac involvement, and its repair and recovery in relation to comorbidity, genetics, patient-reported QoL measures and functional capacity. CLINICAL TRIAL REGISTRATION: ISRCTN 58667920. Registered 04 August 2020.


Subject(s)
COVID-19/complications , Heart Diseases/virology , Research Design , Biomarkers/blood , Comorbidity , Contrast Media , Electrocardiography , Female , Heart Diseases/physiopathology , Humans , Longitudinal Studies , Magnetic Resonance Imaging, Cine , Male , Multicenter Studies as Topic , Myocardial Perfusion Imaging , Observation , Pneumonia, Viral/virology , Prospective Studies , Quality of Life , Risk Factors , SARS-CoV-2 , Troponin/blood , United Kingdom , Walk Test
6.
JACC Case Rep ; 3(6): 971-972, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1265737

ABSTRACT

In patients with acute myocardial injury secondary to coronavirus disease-2019 (COVID-19), cardiovascular magnetic resonance imaging can identify the underlying pathology. We highlight a case of acute myocardial injury secondary to COVID-19, which demonstrated both epicardial vessel thrombosis and the recently described phenomenon of microvascular thrombosis. (Level of Difficulty: Advanced.).

7.
JACC Cardiovasc Imaging ; 14(11): 2155-2166, 2021 11.
Article in English | MEDLINE | ID: covidwho-1225278

ABSTRACT

OBJECTIVES: The purpose of this study was to detect cardiovascular changes after mild severe acute respiratory syndrome-coronavirus-2 infection. BACKGROUND: Concern exists that mild coronavirus disease 2019 may cause myocardial and vascular disease. METHODS: Participants were recruited from COVIDsortium, a 3-hospital prospective study of 731 health care workers who underwent first-wave weekly symptom, polymerase chain reaction, and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post-infection, 74 seropositive and 75 age-, sex-, and ethnicity-matched seronegative control subjects were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated cardiovascular magnetic resonance and blood biomarkers). Analysis was blinded, using objective artificial intelligence analytics where available. RESULTS: A total of 149 subjects (mean age 37 years, range 18 to 63 years, 58% women) were recruited. Seropositive infections had been mild with case definition, noncase definition, and asymptomatic disease in 45 (61%), 18 (24%), and 11 (15%), respectively, with 1 person hospitalized (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass, atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T1, T2, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro-B-type natriuretic peptide). With abnormal defined by the 75 seronegatives (2 SDs from mean, e.g., ejection fraction <54%, septal T1 >1,072 ms, septal T2 >52.4 ms), individuals had abnormalities including reduced ejection fraction (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), late gadolinium enhancement (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all N-terminal pro-B-type natriuretic peptide normal). These were distributed equally between seropositive and seronegative individuals. CONCLUSIONS: Cardiovascular abnormalities are no more common in seropositive versus seronegative otherwise healthy, workforce representative individuals 6 months post-mild severe acute respiratory syndrome-coronavirus-2 infection.


Subject(s)
COVID-19 , Cardiovascular Abnormalities , Adolescent , Adult , Artificial Intelligence , Case-Control Studies , Contrast Media , Female , Gadolinium , Health Personnel , Humans , Magnetic Resonance Imaging, Cine , Male , Middle Aged , Myocardium , Predictive Value of Tests , Prospective Studies , SARS-CoV-2 , Ventricular Function, Left , Young Adult
8.
Am J Med ; 134(4): 482-489, 2021 04.
Article in English | MEDLINE | ID: covidwho-812408

ABSTRACT

PURPOSE: We evaluated whether the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) pandemic was associated with changes in the pattern of acute cardiovascular admissions across European centers. METHODS: We set-up a multicenter, multinational, pan-European observational registry in 15 centers from 12 countries. All consecutive acute admissions to emergency departments and cardiology departments throughout a 1-month period during the COVID-19 outbreak were compared with an equivalent 1-month period in 2019. The acute admissions to cardiology departments were classified into 5 major categories: acute coronary syndrome, acute heart failure, arrhythmia, pulmonary embolism, and other. RESULTS: Data from 54,331 patients were collected and analyzed. Nine centers provided data on acute admissions to emergency departments comprising 50,384 patients: 20,226 in 2020 compared with 30,158 in 2019 (incidence rate ratio [IRR] with 95% confidence interval [95%CI]: 0.66 [0.58-0.76]). The risk of death at the emergency departments was higher in 2020 compared to 2019 (odds ratio [OR] with 95% CI: 4.1 [3.0-5.8], P < 0.0001). All 15 centers provided data on acute cardiology departments admissions: 3007 patients in 2020 and 4452 in 2019; IRR (95% CI): 0.68 (0.64-0.71). In 2020, there were fewer admissions with IRR (95% CI): acute coronary syndrome: 0.68 (0.63-0.73); acute heart failure: 0.65 (0.58-0.74); arrhythmia: 0.66 (0.60-0.72); and other: 0.68(0.62-0.76). We found a relatively higher percentage of pulmonary embolism admissions in 2020: odds ratio (95% CI): 1.5 (1.1-2.1), P = 0.02. Among patients with acute coronary syndrome, there were fewer admissions with unstable angina: 0.79 (0.66-0.94); non-ST segment elevation myocardial infarction: 0.56 (0.50-0.64); and ST-segment elevation myocardial infarction: 0.78 (0.68-0.89). CONCLUSION: In the European centers during the COVID-19 outbreak, there were fewer acute cardiovascular admissions. Also, fewer patients were admitted to the emergency departments with 4 times higher death risk at the emergency departments.


Subject(s)
COVID-19 , Cardiology Service, Hospital/statistics & numerical data , Critical Pathways/organization & administration , Emergency Service, Hospital/statistics & numerical data , Myocardial Ischemia , Patient Admission , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Europe/epidemiology , Female , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , Male , Middle Aged , Myocardial Ischemia/epidemiology , Myocardial Ischemia/therapy , Patient Admission/statistics & numerical data , Patient Admission/trends , Registries/statistics & numerical data , SARS-CoV-2
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