Abstract
BackgroundAlthough coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, myocardial injury is increasingly reported and associated with adverse outcomes. However, the pathophysiology, extent of myocardial injury and clinical significance remains unclear.MethodsCOVID-HEART is a UK, multicentre, prospective, observational, longitudinal cohort study of patients with confirmed COVID-19 and elevated troponin (sex-specific > 99th centile). Baseline assessment will be whilst recovering in-hospital or recently discharged, and include cardiovascular magnetic resonance (CMR) imaging, quality of life (QoL) assessments, electrocardiogram (ECG), serum biomarkers and genetics. Assessment at 6-months includes repeat CMR, QoL assessments and 6-min walk test (6MWT). The CMR protocol includes cine imaging, T1/T2 mapping, aortic distensibility, late gadolinium enhancement (LGE), and adenosine stress myocardial perfusion imaging in selected patients. The main objectives of the study are to: (1) characterise the extent and nature of myocardial involvement in COVID-19 patients with an elevated troponin, (2) assess how cardiac involvement and clinical outcome associate with recognised risk factors for mortality (age, sex, ethnicity and comorbidities) and genetic factors, (3) evaluate if differences in myocardial recovery at 6 months are dependent on demographics, genetics and comorbidities, (4) understand the impact of recovery status at 6 months on patient-reported QoL and functional capacity.DiscussionCOVID-HEART will provide detailed characterisation of cardiac involvement, and its repair and recovery in relation to comorbidity, genetics, patient-reported QoL measures and functional capacity.Clinical Trial registration: ISRCTN 58667920. Registered 04 August 2020.
Highlights
Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, myocardial injury is increasingly reported and associated with adverse outcomes
De novo cardiac complications of COVID-19 may occur [4], with SARS-CoV-2 infection being implicated in acute myocarditis, pericarditis, prothrombotic complications, left ventricular (LV) and/or right ventricular (RV) dysfunction, arrhythmia and ischaemic sequelae in the presence or absence of underlying coronary artery disease (CAD) [1, 4,5,6]
A recent German cohort study reported imaging evidence of myocardial injury defined by cardiovascular magnetic resonance (CMR) in over 70%, whether this was pre-existing or consequence was unclear with single time-point imaging [9]
Summary
Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, myocardial injury is increasingly reported and associated with adverse outcomes. Underlying cardiovascular disease (CVD) can predispose patients to the infection and is associated with an increased illness severity. De novo cardiac complications of COVID-19 may occur [4], with SARS-CoV-2 infection being implicated in acute myocarditis, pericarditis, prothrombotic complications, left ventricular (LV) and/or right ventricular (RV) dysfunction, arrhythmia and ischaemic sequelae in the presence or absence of underlying coronary artery disease (CAD) [1, 4,5,6]. The underlying mechanism of cardiac injury and troponin elevation remains unclear, but there are several potential explanations. Preexisting coronary risk factors, such as hypertension and diabetes predispose patients with COVID-19 to myocardial infarction in the acute setting, possibly implicating it as another potential disease mechanism [15]. Direct myocardial injury may occur due to viral angiotensin-converting enzyme-2 transmembrane receptor mediated damage, microvascular dysfunction or increased vessel wall permeability [16]
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