Clinical Significance of Myocardial Injury in Patients Hospitalized for COVID-19
Authors: Hunain Shiwani, Jessica Artico, James C. Moon, Miroslawa Gorecka, Gerry P. McCann, Giles Roditi, Andrew Morrow, Kenneth Mangion, Elena Lukaschuk, 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, Ranjit Arnold, Robin Young, Alex McConnachie, Stefan Neubauer, Stefan K. Piechnik, Rhodri H. Davies, Vanessa M. Ferreira, Marc R. Dweck, Colin Berry, John P. Greenwood, J.P. Greenwood, G.P. McCann, C. Berry, M. Dweck, C.M. Miller, A. Chiribiri, S. Prasad, V.M. Ferreira, C. Bucciarelli-Ducci, D. Dawson, James C. Moon, Jessica Artico, Hunain Shiwani, Rhodri Davies, Marc Dweck, Colin Berry, Giles Roditi, Robin Young, Alex McConnachie, Bernard Kelly, Peter W. Macfarlane, Christopher A. Miller, Eylem Levelt, Miroslawa Goreka, Kathryn Somers, Roo J. Byrom-Goulthorp, Michelle Anderson, Laura Britton, Fiona Richards, Laura M. Jones, Ranjit Arnold, Alastair Moss, Jude Fisher, Joanne Wormleighton, Kelly Parke, Rachel Wright, Jian Yeo, Dana Dawson, Judith Falconer, Valerie Harries, Paula Henderson, Trisha Singh, David Newby, Stefan Piechnik, Iulia Popescu, Elena Lukaschuk, Qiang Zhang, Mayooran Shanmuganathan, Stefan Neubauer, Betty Raman, Keith Channon, Catherine Krasopoulos, Claudia Nunes, Liliana Da Silva Rodrigues, Harriet Nixon, Athanasia Panopoulou, Alison Fletcher, Peter Manley, Kenneth Mangion, Andrew Morrow, Robert Sykes, Kirsty Fallon, Ammani Brown, Laura Kelly, Christopher McGinley, Michael Briscoe, Rosemary Woodward, Tracey Hopkins, Evonne McLennan, Nicola Tynan, Laura Dymock, Peter Swoboda, Judith Wright, Donna Exley, Richard Steeds, Kady Hutton, Sonia MacDonald, Thomas Treibel, Abhishek Shetye, Christopher M. Miller, Christopher Orsborne, William Woodville-Jones, Susan Ferguson, Konstantinos Bratis, Timothy Fairbairn, Michail Sionas, Peris Widdows, Pei Gee Chew, Christian Marsden, Tom Collins, Linsha George, Lisa Kearney, Andrew Flett, Simon Smith, Alice Zhenge, Jake Harvey, Liliana Inacio, Tomas Hanam-Penfold, Lucy Gruner, Marianna Fontana, Yousuf S.K. Razvi, Jacolene Crause, Nina M. Davies, James T. Brown, Liza Chaco, Rishi Patel, Tushar Kotecha, Dan S. Knight, Thomas Green, David Ripley, Maria Thompson, Amedeo Chiribiri, Ugochi Akerele, Elna Cifra, Ebraham Alskaf, Richard Crawley, Adriana Villa, Chiara Bucciarelli-Ducci, Angus K. Nightingale, Kim Wright, Esther D. Bonnick, Emma Hopkins, Jessy George, Linta Joseph, Graham Cole, Kavitha Vimalesvaran, Nadine Ali, Caitlin R. Carr, Alexandra A.R. Ross, Clara King, Sanjay Prasad, Zohreh Farzad, Sara A. Salmi, Kevin Kirby, Adam McDiarmid, Hannah J. Stevenson, Pamela S. Matsvimbo, Lency Joji, Margaret Fearby, Benjamin Brown, Nicholas Bunce, Robert Jennings, Vennessa Sookhoo, Shatabdi Joshi, Prathap Kanagala, Sandra Fullalove, Catherine Toohey, Kate Fenlon, Nicholas Bellenger, Jingzhou He, Sarah Statton, Nicola Pamphilon, Anna Steele, Claire Ball, Ann McGahey, Silvia Balma, Lynsey Wilkes, Katy Lewis, Michelle Walter, Adrian Ionescu, Tishi Ninan, Suzanne Richards, Marie Williams, Khaled Alfakih, Samia Pilgrim, George Joy, Charlotte H. Manisty, Ifza Hussain
Journal: JACC. Cardiovascular imaging (2024)

BACKGROUND Hospitalized COVID-19 patients with troponin elevation have a higher prevalence of cardiac abnormalities than control individuals.However, the progression and impact of myocardial injury on COVID-19 survivors remain unclear.OBJECTIVES This study sought to evaluate myocardial injury in COVID-19 survivors with troponin elevation with baseline and follow-up imaging and to assess medium-term outcomes.METHODS This was a prospective, longitudinal cohort study in 25 United Kingdom centers (June 2020 to March 2021).Hospitalized COVID-19 patients with myocardial injury underwent cardiac magnetic resonance (CMR) scans within 28 days and 6 months postdischarge.Outcomes were tracked for 12 months, with quality of life surveys (EuroQol-5 Dimension and 36-Item Short Form surveys) taken at discharge and 6 months. RESULTSOf 342 participants (median age: 61.3 years; 71.1% male) with baseline CMR, 338 had a 12-month follow-up, 235 had a 6-month CMR, and 215 has baseline and follow-up quality of life surveys.Of 338 participants, within 12 months, 1.2% died; 1.8% had new myocardial infarction, acute coronary syndrome, or coronary revascularization; 0.8% had new myopericarditis; and 3.3% had other cardiovascular events requiring hospitalization.At 6 months, there was a minor improvement in left ventricular ejection fraction (1.8% AE 1.0%; P < 0.001), stable right ventricular ejection fraction (0.4% AE 0.8%; P ¼ 0.50), no change in myocardial scar pattern or volume (P ¼ 0.26), and no imaging evidence of continued myocardial inflammation.All pericardial effusions (26 of 26) resolved, and most pneumonitis resolved (95 of 101).EuroQol-5 Dimension scores indicated an overall improvement in quality of life (P < 0.001).CONCLUSIONS Myocardial injury in severe hospitalized COVID-19 survivors is nonprogressive.Medium-term outcomes show a low incidence of major adverse cardiovascular events and improved quality of life.(COVID-19 Effects on the Heart; ISRCTN58667920) (JACC