Cardiac pathology 6 months after hospitalization for COVID-19 and association with the acute disease severity

Abstract

Background: Coronavirus disease 2019 (COVID-19) may cause myocardial injury and myocarditis, and reports of persistent cardiac pathology after COVID-19 have raised concerns of long-term cardiac consequences. We aimed to assess the presence of abnormal cardiovascular resonance imaging (CMR) findings in patients recovered from moderate-to-severe COVID-19, and its association with markers of disease severity in the acute phase.

Methods: Fifty-eight (49%) survivors from the prospective COVID MECH study, underwent CMR median 175 [IQR 105-217] days after COVID-19 hospitalization. Abnormal CMR was defined as left ventricular ejection fraction (LVEF) <50% or myocardial scar by late gadolinium enhancement. CMR indices were compared to healthy controls (n = 32), and to circulating biomarkers measured during the index hospitalization.

Results: Abnormal CMR was present in 12 (21%) patients, of whom 3 were classified with major pathology (scar and LVEF <50% or LVEF <40%). There was no difference in the need of mechanical ventilation, length of hospital stay, and vital signs between patients with vs without abnormal CMR after 6 months. Severe acute respiratory syndrome coronavirus 2 viremia and concentrations of inflammatory biomarkers during the index hospitalization were not associated with persistent CMR pathology. Cardiac troponin T and N-terminal pro-B-type natriuretic peptide concentrations on admission, were higher in patients with CMR pathology, but these associations were not significant after adjusting for demographics and established cardiovascular disease.

Conclusions: CMR pathology 6 months after moderate-to-severe COVID-19 was present in 21% of patients and did not correlate with severity of the disease. Cardiovascular biomarkers during COVID-19 were higher in patients with CMR pathology, but with no significant association after adjusting for confounders.

Trial registration: COVID MECH Study ClinicalTrials.gov Identifier: NCT04314232.

Keywords: CMR; COVID-19; NT-proBNP; biomarkers; cardiac magnetic resonance imaging; troponin.

Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Title: Non-ischemic left ventricular (LV) scar by late gadolinium enhancement imaging, Caption: Late gadolinium images demonstrating non-ischemic scars in A, the basal inferolateral LV of a 54-year-old male 209 days after hospitalization for COVID-19; B, the basoseptal LV of a 60 year old male 175 days after hospitalization for COVID-19; and C, the basolateral LV of a 50 year old male 202 days after hospitalization for COVID-19.

Figure 2

Title: Clinical variables and biomarker concentrations during hospitalization for COVID-19 in patients with and without pathology on CMR after 6 months, Caption: Proportion of patients with and without pathology on CMR with need for intensive care unit (ICU) treatment, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) viremia, National Early Warning Score (NEWS) and length of hospital stay during admission for COVID-19, and concentrations of cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and ferritin measured at admission and change to day 3 in patients. CMR pathology was defined as myocardial scar or reduced left ventricular ejection fraction. The whiskers represent quartile 1 to quartile 3 for continuous variables.