Around 50%of clients who have actually been hospitalized with extreme COVID-19 and who reveal raised levels of a protein called troponin have damage to their hearts. The injury was detected by magnetic resonance imaging (MRI) scans at least a month after discharge, according to new findings released today (February 18, 2021) in the European Heart Journal
Damage includes swelling of the heart muscle (myocarditis), scarring or death of heart tissue (infarction), restricted blood supply to the heart (ischaemia) and combinations of all 3.
The research study of 148 patients from 6 severe health centers in London is the largest research study to date to investigate convalescing COVID-19 clients who had actually raised troponin levels indicating a possible problem with the heart.
Troponin is launched into the blood when the heart muscle is injured. Raised levels can occur when an artery becomes obstructed or there is inflammation of the heart. Numerous clients who are hospitalized with COVID-19 have raised troponin levels during the vital health problem phase, when the body mounts an exaggerated immune response to the infection. Troponin levels rose in all the clients in this research study who were then followed up with MRI scans of the heart after discharge in order to understand the causes and extent of the damage.
Teacher Marianna Fontana, teacher of cardiology at University College London (UK), who led the research study together with Dr. Graham Cole, a consultant cardiologist at Imperial College London, said: “Raised troponin levels are related to worse results in COVID-19 clients. Patients with severe COVID-19 illness typically have pre-existing heart-related illness consisting of diabetes, raised high blood pressure and weight problems. Throughout severe COVID-19 infection, however, the heart may also be directly impacted. Unpicking how the heart can end up being harmed is difficult, but MRI scans of the heart can determine various patterns of injury, which may enable us to make more accurate diagnoses and to target treatments more effectively.”
The scientists investigated COVID-19 clients released up till June 2020 from six hospitals across 3 NHS London trusts: Royal Free London NHS Foundation Trust, Imperial College Healthcare NHS Trust and University College London Healthcare Facility NHS Structure Trust. Clients who had irregular troponin levels were used an MRI scan of the heart after discharge and were compared with those from a control group of patients who had actually not had COVID-19, in addition to from 40 healthy volunteers.
” The recuperating COVID-19 patients had been very ill; all required hospitalization and all had troponin elevation, with around one in three having actually been on a ventilator in the intensive care system,” said Prof. Fontana.
” We discovered evidence of high rates of heart muscle injury that might be seen on the scans a month or two after discharge. Whilst some of this might have been pre-existing, MRI scanning shows that some were new, and likely caused by COVID-19 Importantly, the pattern of damage to the heart varied, suggesting that the heart is at danger of different types of injury. While we detected just a percentage of continuous injury, we saw injury to the heart that existed even when the heart’s pumping function was not impaired and might not have been picked up by other methods. In the most extreme cases, there are concerns that this injury may increase the risks of cardiac arrest in the future, but more work is required to examine this even more.”
The function of the heart’s left ventricle, the chamber that is accountable for pumping oxygenated blood to all parts of the body, was normal in 89%of the 148 clients but scarring or injury to the heart muscle was present in 80 clients (54%). The pattern of tissue scarring or injury originated from swelling in 39 patients (26%), ischaemic heart disease, which includes infarction or ischaemia, in 32 patients (22%), or both in 9 clients (6%). Twelve clients (8%) appeared to have continuous heart swelling.
Prof. Fontana stated: “Injury associating with swelling and scarring of the heart prevails in COVID-19 patients with troponin elevation discharged from health center, however is of minimal level and has little consequence for the heart’s function.
” These findings provide us two chances: firstly, to find ways of avoiding the injury in the first place, and from some of the patterns we have actually seen, blood clotting may be contributing, for which we have potential treatments. Discovering the effects of injury throughout convalescence may recognize topics who would benefit from specific supporting drug treatments to protect heart function over time.”
The findings of the study are restricted by the nature of patient choice and included just those who survived a coronavirus infection that required medical facility admission.
” The convalescent patients in this research study had extreme COVID-19 disease and our outcomes state absolutely nothing about what takes place to individuals who are not hospitalized with COVID, or those who are hospitalized but without elevated troponin. More work is needed, and MRI scans of the heart have actually shown how helpful it is in investigating clients with troponin elevation,” concluded Prof. Fontana.
The study is also the subject of a conversation in between Prof. Fontana and Prof. Eike Nagel, at the Society for Cardiovascular Magnetic Resonance yearly conference on Friday 19 February, where it will exist for the first time. Prof. Nagel, director of the Centre for Cardiovascular Imaging at Deutsches Zentrum Für Herz-Kreislauf-Forschung (DZHK), Frankfurt, Germany, is the senior author on an earlier paper that found continuous heart issues in up to 78%of COVID-19 patients who were less ill and the majority of whom did not need admission to healthcare facility.
- ” Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance” by Tushar Kotecha et al., 18 February 2021, European Heart Journal
DOI: 10.1093/ eurheartj/ehab075
- Society for Cardiovascular Magnetic Resonance virtual clinical sessions 2021, 09.
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- ” Results of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recuperated From Coronavirus Disease 2019 (COVID-19)” by Valentina O. Puntmann, MD, PhD; M. Ludovica Carerj, MD; Imke Wieters, MD; Masia Fahim; Christophe Arendt, MD; Jedrzej Hoffmann, MD; Anastasia Shchendrygina, MD, PhD; Felicitas Escher, MD; Mariuca Vasa-Nicotera, MD; Andreas M. Zeiher, MD; Maria Vehreschild, MD and Eike Nagel, MD, 27 July 2021, JAMA Cardiology