More than 50% of Severe COVID-19 Patients Develop Subsequent Heart Damage

Marianna Fontana, MD

A recent study from clinicians in London is sounding the alarm on the potential for damage to the heart as a result of contracting coronavirus disease 2019 (COVID-19).

An analysis of MRI data more than 140 patients discharged from acute care hospitals, results indicate about half of the patients hospitalized with severe COVID-19 with increased troponin levels appeared to suffer from subsequent cardiovascular issues in the following months, with infarction, myocarditis, ischemia, and combinations of all 3 appearing in this patient population.

“Importantly, the pattern of damage to the heart was variable, suggesting that the heart is at risk of different types of injury,” said Marianna Fontana, MD, lead investigator and a professor of cardiology at University College London, in a statement. “While we detected only a small amount of ongoing injury, we saw injury to the heart that was present even when the heart's pumping function was not impaired and might not have been picked up by other techniques. In the most severe cases, there are concerns that this injury may increase the risks of heart failure in the future, but more work is needed to investigate this further.”

With previous studies suggesting severe COVID-19 could have lingering effects on cardiovascular health and those with pre-existing cardiovascular conditions at an increased risk of severe outcomes during an infection, Fontana and a team of colleagues designed the current study to assess the potential for myocardial injury in recovered patients. With this in mind, investigators designed their study as an analysis of patients treated at 6 different London-area hospitals.

For inclusion in the analysis, patients needed to be discharged before June 20, 2020, have a confirmed diagnosis of COVID-19, and have undergone multi-parametric cardiovascular magnetic resonance (CMR) at least 1 month after discharge from the hospital. Additionally, patients were required to have elevated troponin levels, which was defined as hsTnT greater than 14 ng/L for females or greater than 34 ng/L for men, depending on the hospital.

In total, investigators identified 148 patients for inclusion in their analysis. The mean age of this group was 64±12 years, 70% were men, 32% required ventilatory support, and the median time after discharge to CMR was 68 days.

Upon analysis, investigators found patients had a mean LVEF of 89% (67±11%). Results also indicated late gadolinium enhancement or ischemia was observed in 80 of the 148 patients included in the study. Specifically, a myocarditis-like scar was seen in 39 patients, infarction or ischemia was noted in 32 patients, and the presence of both was observed in a group of 9 patients.

When assessing myocarditis-like injuries, investigators pointed out injury was limited to 3 or less myocardial segments in 35 of 40 cases and there was no observed left ventricular dysfunction observed. Additionally, investigators noted 30% of these patients had active myocarditis. Investigators found myocardial infarction in 28 of the 148 patients and inducible ischemia in 20 of 76 with data related to adenosine stress perfusion.

Among portents with an observed ischemic injury pattern (n=41), none of them had a past history of coronary artery disease. Furthermore, investigators noted there was no evidence of diffuse fibrosis or edema in the remote myocardium when comparing COVID-19 patients to matched controls treated prior to January 1, 2020.

"These findings give us two opportunities: firstly, to find ways of preventing the injury in the first place, and from some of the patterns we have seen, blood clotting may be playing a role, for which we have potential treatments. Secondly, detecting the consequences of injury during convalescence may identify subjects who would benefit from specific supporting drug treatments to protect heart function over time,” added Fontana.

This study, “Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance,” was published in the European Heart Journal.