Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

J Ranjit Arnold; Jian L Yeo; Charley A Budgeon; Simran Shergill; Rachel England; Hunain Shiwani; Jessica Artico; James C Moon; Miroslawa Gorecka; Giles Roditi; Andrew Morrow; Kenneth Mangion; Mayooran Shanmuganathan; Christopher A Miller; Amedeo Chiribiri; Mohammed Alzahir; Sara Ramirez; Andrew Lin; Peter P Swoboda; Adam K McDiarmid; Robert Sykes; Trisha Singh; Chiara Bucciarelli-Ducci; Dana Dawson; Marianna Fontana; Charlotte Manisty; Thomas A Treibel; Eylem Levelt; Robin Young; Alex McConnachie; Stefan Neubauer; Stefan K Piechnik; Rhodri H Davies; Vanessa M Ferreira; Marc R Dweck; Colin Berry; Oxford Acute Myocardial Infarction OxAMI Study Investigators; COVID-HEART investigators; Gerry P McCann; John P Greenwood

doi:10.1007/s10554-024-03304-7

Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

Int J Cardiovasc Imaging. 2024 Dec 30. doi: 10.1007/s10554-024-03304-7. Online ahead of print.

Authors

J Ranjit Arnold¹, Jian L Yeo², Charley A Budgeon^{2

3}, Simran Shergill², Rachel England², Hunain Shiwani⁴, Jessica Artico⁴, James C Moon⁴, Miroslawa Gorecka⁵, Giles Roditi⁶, Andrew Morrow⁷, Kenneth Mangion⁷, Mayooran Shanmuganathan^{8

9

10}, Christopher A Miller¹¹, Amedeo Chiribiri¹², Mohammed Alzahir⁴, Sara Ramirez⁴, Andrew Lin⁴, Peter P Swoboda⁵, Adam K McDiarmid¹³, Robert Sykes⁷, Trisha Singh¹⁴, Chiara Bucciarelli-Ducci^{12

15

16

17}, Dana Dawson¹⁸, Marianna Fontana¹⁹, Charlotte Manisty⁴, Thomas A Treibel⁴, Eylem Levelt⁵, Robin Young²⁰, Alex McConnachie²⁰, Stefan Neubauer⁸, Stefan K Piechnik⁸, Rhodri H Davies⁴, Vanessa M Ferreira⁸, Marc R Dweck¹⁴, Colin Berry⁷; Oxford Acute Myocardial Infarction OxAMI Study Investigators; COVID-HEART investigators; Gerry P McCann², John P Greenwood^{5

21}

Affiliations

¹ University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK. [email protected].
² University of Leicester and The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
³ Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia, Perth, Australia.
⁴ Institute of Cardiovascular Science, University College London, London, UK.
⁵ Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁶ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
⁷ Institute of Cardiovascular and Medical Sciences and British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
⁸ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.
⁹ British Heart Foundation Centre of Research Excellence, Oxford, UK.
¹⁰ Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
¹¹ Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
¹² School of Biomedical Engineering and Imaging Sciences, King's College London, BHF Centre of Excellence and The NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, The Rayne Institute, St. Thomas' Hospital, London, UK.
¹³ Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
¹⁴ University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK.
¹⁵ Royal Brompton and Harefield Hospitals, London, UK.
¹⁶ Guys' and St Thomas NHS Trust, London, UK.
¹⁷ Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK.
¹⁸ Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, UK.
¹⁹ Division of Medicine, Royal Free Hospital, University College London, London, UK.
²⁰ Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
²¹ Baker Heart and Diabetes Institute, Melbourne, Australia.

PMID: 39738791
DOI: 10.1007/s10554-024-03304-7

Abstract

The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin + , age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID -/comorbidity + , 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.

Keywords: COVID-19; Cardiovascular diseases; Coronavirus; Magnetic resonance imaging; Myocardial ischaemia.

Grants and funding

COV0254/NIHR and UKRI COVID-19 Rapid Response Rolling Call