Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study

OxAMI (Oxford Acute Myocardial Infarction Study) Investigators; COVID-HEART Investigators†

doi:10.1161/CIRCULATIONAHA.122.060632

Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study

OxAMI (Oxford Acute Myocardial Infarction Study) Investigators; COVID-HEART Investigators†

Research output: Contribution to journal › Article › peer-review

29 Citations (Scopus)

5 Downloads (Pure)

Abstract

BACKGROUND: Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation.

METHODS: Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin-) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID-/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months.

RESULTS: Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin-] versus 31% [COVID-/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 ( P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12-4.57]; P=0.02).

CONCLUSIONS: Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction.

REGISTRATION: URL: https://www.isrctn.com; Unique identifier: 58667920.

Original language	English
Pages (from-to)	364-374
Number of pages	11
Journal	Circulation
Volume	147
Issue number	5
Early online date	27 Jan 2023
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.122.060632
Publication status	Published - 31 Jan 2023

Bibliographical note

Dr Berry acknowledges British Heart Foundation support (grant RE/18/6134217). Dr Artico received funding from the European Association of Cardiovascular Imaging (EACVI research grant App000073878). Dr McCann is funded by an NIHR research professorship (RP-2017-08-ST2-007). Dr Manisty is funded by an NIHR clinician scientist award (CS-2015-15-003). Drs Ferreira, Piechnik, and Neubauer thank the NIHR Oxford Biomedical Research Centre for support of this study. Dr Bucciarelli-Ducci is supported in part by the NIHR Biomedical Research Centre at University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol. Additional support was provided by the NIHR Leicester Biomedical Research Centre and the NIHR Leeds Clinical Research Facility. Dr Dweck is supported by the British Heart Foundation (grant FS/SCRF/21/32010). The authors thank the patients and staff who supported this project.
Supported by NIHR and UK Research and Innovation (COV0254). West Yorkshire and Humber Clinical Research Network (CV070) funded patient information leaflet translation.

Keywords

cardiovascular diseases
coronavirus
COVID-19
magnetic resonance imaging
myocardial infarction
troponin

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1161/CIRCULATIONAHA.122.060632Licence: CC BY

Artico_etal_Circ_Myocardial_Involvment_After_VOR
© 2023 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited. https://creativecommons.org/licenses/by/4.0/
Final published version, 600 KBLicence: CC BY

Cite this

@article{97f9b1faa5694e0d90551a7ee3d7d5b2,

title = "Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study",

abstract = "BACKGROUND: Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation.METHODS: Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin-) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID-/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months.RESULTS: Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin-] versus 31% [COVID-/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 ( P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12-4.57]; P=0.02). CONCLUSIONS: Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction.REGISTRATION: URL: https://www.isrctn.com; Unique identifier: 58667920.",

keywords = "cardiovascular diseases, coronavirus, COVID-19, magnetic resonance imaging, myocardial infarction, troponin",

author = "Jessica Artico and Hunain Shiwani and Moon, {James C} and Miroslawa Gorecka and McCann, {Gerry P} and Giles Roditi and Andrew Morrow and Kenneth Mangion and Elena Lukaschuk and Mayooran Shanmuganathan and Miller, {Christopher A} and Amedeo Chiribiri and Prasad, {Sanjay K} and Adam, {Robert D} and Trisha Singh and Chiara Bucciarelli-Ducci and Dana Dawson and Daniel Knight and Marianna Fontana and Charlotte Manisty and Treibel, {Thomas A} and Eylem Levelt and Ranjit Arnold and Macfarlane, {Peter W} and Robin Young and Alex McConnachie and Stefan Neubauer and Piechnik, {Stefan K} and Davies, {Rhodri H} and Ferreira, {Vanessa M} and Dweck, {Marc R} and Colin Berry and Greenwood, {John P} and {OxAMI (Oxford Acute Myocardial Infarction Study) Investigators; COVID-HEART Investigators†}",

note = "Dr Berry acknowledges British Heart Foundation support (grant RE/18/6134217). Dr Artico received funding from the European Association of Cardiovascular Imaging (EACVI research grant App000073878). Dr McCann is funded by an NIHR research professorship (RP-2017-08-ST2-007). Dr Manisty is funded by an NIHR clinician scientist award (CS-2015-15-003). Drs Ferreira, Piechnik, and Neubauer thank the NIHR Oxford Biomedical Research Centre for support of this study. Dr Bucciarelli-Ducci is supported in part by the NIHR Biomedical Research Centre at University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol. Additional support was provided by the NIHR Leicester Biomedical Research Centre and the NIHR Leeds Clinical Research Facility. Dr Dweck is supported by the British Heart Foundation (grant FS/SCRF/21/32010). The authors thank the patients and staff who supported this project. Supported by NIHR and UK Research and Innovation (COV0254). West Yorkshire and Humber Clinical Research Network (CV070) funded patient information leaflet translation. ",

year = "2023",

month = jan,

day = "31",

doi = "10.1161/CIRCULATIONAHA.122.060632",

language = "English",

volume = "147",

pages = "364--374",

journal = "Circulation",

issn = "0009-7322",

publisher = "American Heart Association",

number = "5",

}

TY - JOUR

T1 - Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation

T2 - A Prospective, Multicenter, Observational Study

AU - Artico, Jessica

AU - Shiwani, Hunain

AU - Moon, James C

AU - Gorecka, Miroslawa

AU - McCann, Gerry P

AU - Roditi, Giles

AU - Morrow, Andrew

AU - Mangion, Kenneth

AU - Lukaschuk, Elena

AU - Shanmuganathan, Mayooran

AU - Miller, Christopher A

AU - Chiribiri, Amedeo

AU - Prasad, Sanjay K

AU - Adam, Robert D

AU - Singh, Trisha

AU - Bucciarelli-Ducci, Chiara

AU - Dawson, Dana

AU - Knight, Daniel

AU - Fontana, Marianna

AU - Manisty, Charlotte

AU - Treibel, Thomas A

AU - Levelt, Eylem

AU - Arnold, Ranjit

AU - Macfarlane, Peter W

AU - Young, Robin

AU - McConnachie, Alex

AU - Neubauer, Stefan

AU - Piechnik, Stefan K

AU - Davies, Rhodri H

AU - Ferreira, Vanessa M

AU - Dweck, Marc R

AU - Berry, Colin

AU - Greenwood, John P

AU - OxAMI (Oxford Acute Myocardial Infarction Study) Investigators; COVID-HEART Investigators†

N1 - Dr Berry acknowledges British Heart Foundation support (grant RE/18/6134217). Dr Artico received funding from the European Association of Cardiovascular Imaging (EACVI research grant App000073878). Dr McCann is funded by an NIHR research professorship (RP-2017-08-ST2-007). Dr Manisty is funded by an NIHR clinician scientist award (CS-2015-15-003). Drs Ferreira, Piechnik, and Neubauer thank the NIHR Oxford Biomedical Research Centre for support of this study. Dr Bucciarelli-Ducci is supported in part by the NIHR Biomedical Research Centre at University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol. Additional support was provided by the NIHR Leicester Biomedical Research Centre and the NIHR Leeds Clinical Research Facility. Dr Dweck is supported by the British Heart Foundation (grant FS/SCRF/21/32010). The authors thank the patients and staff who supported this project. Supported by NIHR and UK Research and Innovation (COV0254). West Yorkshire and Humber Clinical Research Network (CV070) funded patient information leaflet translation.

PY - 2023/1/31

Y1 - 2023/1/31

N2 - BACKGROUND: Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation.METHODS: Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin-) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID-/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months.RESULTS: Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin-] versus 31% [COVID-/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 ( P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12-4.57]; P=0.02). CONCLUSIONS: Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction.REGISTRATION: URL: https://www.isrctn.com; Unique identifier: 58667920.

AB - BACKGROUND: Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation.METHODS: Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin-) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID-/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months.RESULTS: Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin-] versus 31% [COVID-/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 ( P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12-4.57]; P=0.02). CONCLUSIONS: Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction.REGISTRATION: URL: https://www.isrctn.com; Unique identifier: 58667920.

KW - cardiovascular diseases

KW - coronavirus

KW - COVID-19

KW - magnetic resonance imaging

KW - myocardial infarction

KW - troponin

U2 - 10.1161/CIRCULATIONAHA.122.060632

DO - 10.1161/CIRCULATIONAHA.122.060632

M3 - Article

C2 - 36705028

SN - 0009-7322

VL - 147

SP - 364

EP - 374

JO - Circulation

JF - Circulation

IS - 5

ER -

Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this