21 Oct 21. Featured Paper

Link to paper on Heart

 

Authors

Trisha Singh, Thomas A Kite, Shruti S Joshi, Nick B Spath, Lucy Kershaw, Andrew Baker, Helen Jordan, Gaurav Singh Gulsin, Michelle Claire Williams, Edwin J R van Beek, Jayanth Ranjit Arnold, Scott I K Semple, Alastair James Moss, David E Newby, Marc Dweck, Gerry P McCann

 

Abstract

Objectives: To determine the contribution of comorbidities on the reported widespread myocardial abnormalities in patients with recent COVID-19.

Methods: In a prospective two-centre observational study, patients hospitalised with confirmed COVID-19 underwent gadolinium & manganese-enhanced MRI & CT coronary angiography (CTCA).

They were compared with healthy & comorbidity-matched volunteers after blinded analysis.

Results: In 52 patients (median age: 54 (IQR 51–57) years, 39 males) who recovered from COVID-19, one-third (n=15, 29%) were admitted to intensive care & a fifth (n=11, 21%) were ventilated.

Twenty-three patients underwent CTCA, with one-third having underlying coronary artery disease (n=8, 35%).

Compared with younger healthy volunteers (n=10), patients demonstrated reduced left (ejection fraction (EF): 57.4±11.1 (95% CI 54.0 to 60.1) versus 66.3±5 (95 CI 62.4 to 69.8)%; p=0.02) & right (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 60.5±4.9 (95% CI 57.1 to 63.2)%; p≤0.0001) ventricular systolic function with elevated native T1 values (1225±46 (95% CI 1205 to 1240) vs 1197±30 (95% CI 1178 to 1216) ms;p=0.04) & extracellular volume fraction (ECV) (31±4 (95% CI 29.6 to 32.1) vs 24±3 (95% CI 22.4 to 26.4)%; p<0.0003) but reduced myocardial manganese uptake (6.9±0.9 (95% CI 6.5 to 7.3) vs 7.9±1.2 (95% CI 7.4 to 8.5) mL/100 g/min; p=0.01).

Compared with comorbidity-matched volunteers (n=26), patients had preserved left ventricular function but reduced right ventricular systolic function (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 59.3±4.9 (95% CI 51.0 to 66.5)%; p=0.0005) with comparable native T1 values (1225±46 (95% CI 1205 to 1240) vs 1227±51 (95% CI 1208 to 1246) ms; p=0.99), ECV (31±4 (95% CI 29.6 to 32.1) vs 29±5 (95% CI 27.0 to 31.2)%; p=0.35), presence of late gadolinium enhancement & manganese uptake.

These findings remained irrespective of COVID-19 disease severity, presence of myocardial injury or ongoing symptoms.

Conclusions: Patients demonstrate right but not left ventricular dysfunction.

Previous reports of left ventricular myocardial abnormalities following COVID-19 may reflect pre-existing comorbidities.

 

Keywords

• COVID-19
• CT coronary angiography (CTCA)
• Myocardial abnormalities