multi-modality imaging & immunophenotyping of covid-19 related myocardial injury

Conditions: COVID19; Cardiovascular Diseases

Summary: cardiovascular involvement in coronavirus disease-2019 (covid-19) encompasses a wide range of vascular and myocardial pathologies, including both acute and long-term sequelae. the miic-mi study aims to investigate mechanisms of cardiac injury in covid-19 using multi-modality imaging and immunophenotyping to better understand the link with adverse patient outcomes.

cardiovascular involvement in coronavirus disease-2019 (covid-19) encompasses a wide range of vascular and myocardial pathologies, including both acute and long-term sequelae. cardiac troponin elevation, a marker of acute myocardial injury, has been identified in up to 28% of hospitalized patients with coronavirus disease 2019 (covid-19) and is associated with an increased mortality risk. however, the predominant aetiology of myocardial injury relating to covid-19 remains unclear. the troponin leak could either signify direct cardiac involvement in covid-19 or serve as a non-specific marker of a severe systemic insult. there have been numerous reports of acute myocarditis in patients with covid-19. other contributory mechanisms of cardiac troponin elevation in patients with covid-19 that are also driven by a proinflammatory state include acute myocardial infarction due to atherosclerotic plaque rupture (type 1) or demand ischemia (type 2), endothelial and microvascular dysfunction, immune-mediated activation of coagulation and fibrinolytic systems, and stress cardiomyopathy. longer-term effects of covid-19 on the cardiovascular system are also unknown. many individuals with post-acute sequalae of sars-cov-2 infection (or 'long covid') have unexplained cardiac symptoms. patients may also present with new-onset heart failure after covid-19, which is not attributed to another cause. we aim to identify patterns of myocardial injury in covid-19 using non-invasive multi-modality cardiac imaging, paired with cytokine/chemokine testing, immunophenotyping of peripheral blood cells and coagulation profiles. a better understanding of the mechanisms underlying the excess mortality risk attributable to myocardial injury in covid-19 is needed and may help to improve patient care.

Eligibility criteria:
inclusion criteria: * patients \>18 years old * confirmed covid-19 infection and troponin i elevation \>99th percentile of upper reference limit or new-onset heart failure or unexplained cardiac symptoms * able to give written, informed consent exclusion criteria: * women of child-bearing potential not using adequate contraception * contra-indication to mri scanning * contrast allergy or contrast-nephropathy * chronic kidney disease (egfr \<30 ml/min/1.73 m2) * previous myocardial infarction * uncontrolled atrial fibrillation * uncontrolled chronic inflammatory disease * severe lymphopenia (\<0.2 x109/l) * treatment with immunomodulatory therapies within the last month (excluding inhaled or topical steroid therapy) * any medical condition, in the opinion of the investigator, that prevents the participant from lying flat during scanning, or from participating in the study