Covid
19 and Heart Damage
Original Investigation
July 27, 2020
Outcomes of Cardiovascular Magnetic Resonance Imaging in
Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)
Valentina
O. Puntmann, MD, PhD1; M. Ludovica Carerj, MD1,2; Imke Wieters, MD3; et alMasia Fahim3; Christophe Arendt, MD1,4; Jedrzej Hoffmann, MD1,5; Anastasia Shchendrygina, MD, PhD1,6; Felicitas Escher, MD7; Mariuca Vasa-Nicotera, MD5; Andreas M. Zeiher, MD5; Maria Vehreschild, MD3; Eike Nagel, MD1
JAMA Cardiol. Published online July 27,
2020. doi:10.1001/jamacardio.2020.3557
Key Points
Question What are the cardiovascular effects in unselected
patients with recent coronavirus disease 2019 (COVID-19)?
Findings In this
cohort study including 100 patients recently recovered from COVID-19 identified
from a COVID-19 test center, cardiac magnetic resonance imaging revealed
cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in
60 patients (60%), which was independent of preexisting conditions, severity
and overall course of the acute illness, and the time from the original diagnosis.
Meaning These
findings indicate the need for ongoing investigation of the long-term
cardiovascular consequences of COVID-19.
Abstract
Importance Coronavirus
disease 2019 (COVID-19) continues to cause considerable morbidity and mortality
worldwide. Case reports of hospitalized patients suggest that COVID-19
prominently affects the cardiovascular system, but the overall impact remains
unknown.
Objective To
evaluate the presence of myocardial injury in unselected patients recently
recovered from COVID-19 illness.
Design, Setting, and Participants In this prospective observational cohort study, 100
patients recently recovered from COVID-19 illness were identified from the
University Hospital Frankfurt COVID-19 Registry between April and June 2020.
Exposure Recent
recovery from severe acute respiratory syndrome coronavirus 2 infection, as
determined by reverse transcription–polymerase chain reaction on swab test of
the upper respiratory tract.
Main Outcomes and Measures Demographic
characteristics, cardiac blood markers, and cardiovascular magnetic resonance
(CMR) imaging were obtained. Comparisons were made with age-matched and
sex-matched control groups of healthy volunteers (n = 50) and risk
factor–matched patients (n = 57).
Results Of the
100 included patients, 53 (53%) were male, and the median (interquartile range
[IQR]) age was 49 (45-53) years. The median (IQR) time interval between
COVID-19 diagnosis and CMR was 71 (64-92) days. Of the 100 patients recently
recovered from COVID-19, 67 (67%) recovered at home, while 33 (33%) required
hospitalization. At the time of CMR, high-sensitivity troponin T (hsTnT) was
detectable (3 pg/mL or greater) in 71 patients recently recovered from COVID-19
(71%) and significantly elevated (13.9 pg/mL or greater) in 5 patients (5%).
Compared with healthy controls and risk factor–matched controls, patients
recently recovered from COVID-19 had lower left ventricular ejection fraction,
higher left ventricle volumes, higher left ventricle mass, and raised native T1
and T2. A total of 78 patients recently recovered from COVID-19 (78%) had
abnormal CMR findings, including raised myocardial native T1 (n = 73), raised
myocardial native T2 (n = 60), myocardial late gadolinium enhancement (n = 32),
and pericardial enhancement (n = 22). There was a small but significant
difference between patients who recovered at home vs in the hospital for native
T1 mapping (median [IQR], 1122 [1113-1132] ms vs 1143 [1131-1156] ms; P = .02) but not for native T2 mapping or hsTnT
levels. None of these measures were correlated with time from COVID-19
diagnosis (native T1: r = 0.07; P = .47; native T2: r = 0.14; P = .15; hsTnT: r = −0.07; P = .50). High-sensitivity troponin T was
significantly correlated with native T1 mapping (r = 0.35; P < .001) and native T2 mapping (r = 0.22; P = .03).
Endomyocardial biopsy in patients with severe findings revealed active
lymphocytic inflammation. Native T1 and T2 were the measures with the best
discriminatory ability to detect COVID-19–related myocardial pathology.
Conclusions and Relevance In
this study of a cohort of German patients recently recovered from COVID-19
infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing
myocardial inflammation in 60 patients (60%), independent of preexisting
conditions, severity and overall course of the acute illness, and time from the
original diagnosis. These findings indicate the need for ongoing investigation
of the long-term cardiovascular consequences of COVID-19.