Abstract
Background8–28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-d-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections.MethodsThis is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA and 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels.DiscussionThe results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic.Trial Registration: This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at https://www.isrctn.com/ISRCTN12154994
Highlights
The number of people diagnosed with the coronavirus disease 2019 (COVID-19) [1] has surpassed 150 million worldwide claiming over 3.2 million deaths [2]
In order to understand cardiac complications secondary to COVID-19, this study aims to utilise multimodality cardiac imaging to identify any morphological and functional cardiovascular changes associated with infection
Whilst data has shown that myocardial injury is prevalent in patients with COVID-19, cardiac imaging has either been limited to case reports and small case series, performed after recovery using single modalities or using study designs highly susceptible to selection/ reporting [8,9,10]
Summary
The number of people diagnosed with the coronavirus disease 2019 (COVID-19) [1] has surpassed 150 million worldwide claiming over 3.2 million deaths [2]. The cardiovascular pathology of injury in COVID-19 patients remain poorly understood, with the underlying mechanism being speculative [6, 7]. Using cardiac magnetic resonance (CMR) imaging [11,12,13], computed tomography coronary angiogram (CTCA) [14] and positron emission tomography with 2-deoxy2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG-PET/CT) [15] during acute COVID-19 infection, we intend to investigate structural and functional changes of the myocardium and arterial vasculature, including evidence of inflammation, fibrosis and prevalence of underlying coronary atherosclerosis. Our principal aims are to identify the cardiac pathophysiological mechanisms related to COVID-19 infection that would influence care and clinical outcomes and provide insight into potential therapeutic targets
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