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Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance.
Kotecha, Tushar; Knight, Daniel S; Razvi, Yousuf; Kumar, Kartik; Vimalesvaran, Kavitha; Thornton, George; Patel, Rishi; Chacko, Liza; Brown, James T; Coyle, Clare; Leith, Donald; Shetye, Abhishek; Ariff, Ben; Bell, Robert; Captur, Gabriella; Coleman, Meg; Goldring, James; Gopalan, Deepa; Heightman, Melissa; Hillman, Toby; Howard, Luke; Jacobs, Michael; Jeetley, Paramjit S; Kanagaratnam, Prapa; Kon, Onn Min; Lamb, Lucy E; Manisty, Charlotte H; Mathurdas, Palmira; Mayet, Jamil; Negus, Rupert; Patel, Niket; Pierce, Iain; Russell, Georgina; Wolff, Anthony; Xue, Hui; Kellman, Peter; Moon, James C; Treibel, Thomas A; Cole, Graham D; Fontana, Marianna.
  • Kotecha T; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Knight DS; Institute of Cardiovascular Science, University College London, UK.
  • Razvi Y; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Kumar K; Institute of Cardiovascular Science, University College London, UK.
  • Vimalesvaran K; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Thornton G; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Patel R; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Chacko L; Institute of Cardiovascular Science, University College London, UK.
  • Brown JT; Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK.
  • Coyle C; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Leith D; Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK.
  • Shetye A; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Ariff B; Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK.
  • Bell R; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Captur G; Institute of Cardiovascular Science, University College London, UK.
  • Coleman M; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Goldring J; National Heart and Lung Institute, Imperial College London, UK.
  • Gopalan D; Institute of Cardiovascular Science, University College London, UK.
  • Heightman M; Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK.
  • Hillman T; Institute of Cardiovascular Science, University College London, UK.
  • Howard L; Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK.
  • Jacobs M; University College London Hospitals NHS Trust, London, UK.
  • Jeetley PS; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Kanagaratnam P; Institute of Cardiovascular Science, University College London, UK.
  • Kon OM; University College London Hospitals NHS Trust, London, UK.
  • Lamb LE; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Manisty CH; Institute of Cardiovascular Science, University College London, UK.
  • Mathurdas P; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Mayet J; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Negus R; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Patel N; University College London Hospitals NHS Trust, London, UK.
  • Pierce I; University College London Hospitals NHS Trust, London, UK.
  • Russell G; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Wolff A; National Heart and Lung Institute, Imperial College London, UK.
  • Xue H; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Kellman P; Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK.
  • Moon JC; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Treibel TA; National Heart and Lung Institute, Imperial College London, UK.
  • Cole GD; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
  • Fontana M; National Heart and Lung Institute, Imperial College London, UK.
Eur Heart J ; 42(19): 1866-1878, 2021 05 14.
Article in English | MEDLINE | ID: covidwho-1087735
Semantic information from SemMedBD (by NLM)
1. myocardial injury PROCESS_OF Patients
Subject
myocardial injury
Predicate
PROCESS_OF
Object
Patients
2. Elevation procedure TREATS COVID-19
Subject
Elevation procedure
Predicate
TREATS
Object
COVID-19
3. Elevation procedure USES Troponin
Subject
Elevation procedure
Predicate
USES
Object
Troponin
4. COVID-19 PROCESS_OF hospitalized patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
hospitalized patients
5. Elevation procedure TREATS hospitalized patients
Subject
Elevation procedure
Predicate
TREATS
Object
hospitalized patients
6. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
7. Coronary Arteriosclerosis PROCESS_OF Patients
Subject
Coronary Arteriosclerosis
Predicate
PROCESS_OF
Object
Patients
8. myocardial injury PROCESS_OF Patients
Subject
myocardial injury
Predicate
PROCESS_OF
Object
Patients
9. Elevation procedure TREATS COVID-19
Subject
Elevation procedure
Predicate
TREATS
Object
COVID-19
10. Elevation procedure USES Troponin
Subject
Elevation procedure
Predicate
USES
Object
Troponin
11. COVID-19 PROCESS_OF hospitalized patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
hospitalized patients
12. Elevation procedure TREATS hospitalized patients
Subject
Elevation procedure
Predicate
TREATS
Object
hospitalized patients
13. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
14. Coronary Arteriosclerosis PROCESS_OF Patients
Subject
Coronary Arteriosclerosis
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

BACKGROUND:

Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients. METHODS AND

RESULTS:

One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1 COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2 COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms).

CONCLUSIONS:

During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Myocarditis Type of study: Observational study / Prognostic study Limits: Female / Humans / Male Language: English Journal: Eur Heart J Year: 2021 Document Type: Article Affiliation country: Eurheartj

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Myocarditis Type of study: Observational study / Prognostic study Limits: Female / Humans / Male Language: English Journal: Eur Heart J Year: 2021 Document Type: Article Affiliation country: Eurheartj