학술논문
Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study
Document Type
Academic Journal
Author
Artico, Jessica; Shiwani, Hunain; Moon, James C.; Gorecka, Miroslawa; McCann, Gerry P.; Roditi, Giles; Morrow, Andrew; Mangion, Kenneth; Lukaschuk, Elena; Shanmuganathan, Mayooran; Miller, Christopher A.; Chiribiri, Amedeo; Prasad, Sanjay K.; Adam, Robert D.; Singh, Trisha; Bucciarelli-Ducci, Chiara; Dawson, Dana; Knight, Daniel; Fontana, Marianna; Manisty, Charlotte; Treibel, Thomas A.; Levelt, Eylem; Arnold, Ranjit; Macfarlane, Peter W.; Young, Robin; McConnachie, Alex; Neubauer, Stefan; Piechnik, Stefan K.; Davies, Rhodri H.; Ferreira, Vanessa M.; Dweck, Marc R.; Berry, Colin; Greenwood, John P.; Kelly, Bernard; Goreka, Miroslawa; Somers, Kathryn; Byrom-Goulthorp, Roo J.; Anderson, Michelle; Britton, Laura; Richards, Fiona; Jones, Laura M.; Moss, Alastair; Fisher, Jude; Wormleighton, Joanne; Parke, Kelly; Wright, Rachel; Yeo, Jian; Falconer, Judith; Harries, Valerie; Henderson, Paula; Newby, David; Popescu, Iulia; Zhang, Qiang; Raman, Betty; Channon, Keith; Krasopoulos, Catherine; Nunes, Claudia; Da Silva Rodrigues, Liliana; Nixon, Harriet; Panopoulou, Athanasia; Fletcher, Alison; Manley, Peter; Sykes, Robert; Fallon, Kirsty; Brown, Ammani; Kelly, Laura; McGinley, Christopher; Briscoe, Michael; Woodward, Rosemary; Hopkins, Tracey; McLennan, Evonne; Tynan, Nicola; Dymock, Laura; Swoboda, Peter; Wright, Judith; Exley, Donna; Steeds, Richard; Hutton, Kady; MacDonald, Sonia; Shetye, Abhishek; Orsborne, Christopher; Woodville-Jones, William; Ferguson, Susan; Bratis, Konstantinos; Fairbairn, Timothy; Sionas, Michail; Widdows, Peris; Gee Chew, Pei; Marsden, Christian; Collins, Tom; George, Linsha; Kearney, Lisa; Flett, Andrew; Smith, Simon; Zhenge, Alice; Harvey, Jake; Inacio, Liliana; Hanam-Penfold, Tomas; Gruner, Lucy; Razvi, Yousuf S.K.; Crause, Jacolene; Davies, Nina M.; Brown, James T.; Chaco, Liza; Patel, Rishi; Kotecha, Tushar; Knight, Dan S.; Green, Thomas; Ripley, David; Thompson, Maria; Cifra, Ugochi Akerele Elna; Alskaf, Ebraham; Crawley, Richard; Villa, Adriana; Nightingale, Angus K.; Wright, Kim; Bonnick, Esther D.; Hopkins, Emma; George, Jessy; Joseph, Linta; Cole, Graham; Vimalesvaran, Kavitha; Ali, Nadine; Carr, Caitlin R.; Ross, Alexandra A.R.; King, Clara; Farzad, Zohreh; Salmi, Sara A.; Kirby, Kevin; McDiarmid, Adam; Stevenson, Hannah J.; Matsvimbo, Pamela S.; Joji, Lency; Fearby, Margaret; Brown, Benjamin; Bunce, Nicholas; Jennings, Robert; Sookhoo, Vennessa; Joshi, Shatabdi; Kanagala, Prathap; Fullalove, Sandra; Toohey, Catherine; Fenlon, Kate; Bellenger, Nicholas; He, Jingzhou; Statton, Sarah; Pamphilon, Nicola; Steele, Anna; Ball, Claire; McGahey, Ann; Balma, Silvia; Wilkes, Lynsey; Lewis, Katy; Walter, Michelle; Ionescu, Adrian; Ninan, Tishi; Richards, Suzanne; Williams, Marie; Alfakih, Khaled; Pilgrim, Samia; Joy, George; Hussain, Ifza
Source
Circulation. Jan 02, 2023
Subject
Language
English
ISSN
0009-7322
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.