UKRI COVID-HEART
Published: 6 February 2023
We are proud to announce the successful completion of the Covid-Heart study, led by the exceptional team from Glasgow.
Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study
Jessica Artico , MD* ; Hunain Shiwani , BMBS* ; James C. Moon, MD*; Miroslawa Gorecka, MB; Gerry P. McCann, MD; Giles Roditi, MD; Andrew Morrow, PhD; Kenneth Mangion , PhD; Elena Lukaschuk, MSc; Mayooran Shanmuganathan , MBBS; Christopher A. Miller , PhD; Amedeo Chiribiri, PhD; Sanjay K. Prasad, MD; Robert D. Adam , MBBS; Trisha Singh , MBBS; Chiara Bucciarelli-Ducci , PhD; Dana Dawson , PhD; Daniel Knight , MD; Marianna Fontana , PhD; Charlotte Manisty , PhD; Thomas A. Treibel, PhD; Eylem Levelt , PhD; Ranjit Arnold , MD; Peter W. Macfarlane , DSc; Robin Young, PhD; Alex McConnachie , PhD; Stefan Neubauer , MD; Stefan K. Piechnik , PhD; Rhodri H. Davies, PhD; Vanessa M. Ferreira , PhD; Marc R. Dweck , PhD; Colin Berry , PhD; OxAMI (Oxford Acute Myocardial Infarction Study)
We are proud to announce the successful completion of the Covid-Heart study, led by the exceptional team from Glasgow. The study highlights the major efforts and contributions of the team during pandemic.
From the very beginning, the Glasgow team played a crucial role in the conception and grant writing of the study. They also took charge of the design, recruitment, core imaging analysis, data coordination, and statistical analysis, all while working diligently to ensure that the study was conducted with the highest standards of quality and ethics.
At the heart of this study was the Robertson Centre for Biostatistics, which provided invaluable support and guidance throughout the entire process. The team's expertise and dedication allowed for the collection and analysis of extensive data, and the resulting insights will play a significant role in advancing our understanding of the effects of Covid-19 on the heart.
The Covid-Heart study is a testament to the resilience and perseverance of the Glasgow team, who worked tirelessly to ensure that the study was completed on time and to the highest standards. Their commitment to advancing science and improving patient care is truly commendable and we would like to extend our sincerest congratulations to each and every member of the team.
Thank you for your continued efforts and dedication to this groundbreaking study. We look forward to seeing the impact of your work in the years to come.
BACKGROUND
Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation.
METHODS
Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin−) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID−/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months.
RESULTS
Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin−] versus 31% [COVID−/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 (P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12–4.57]; P=0.02).
Editorial
Acute Myocardial Injury in the COVID-HEART Study: Emphasizing Scars While Reassuring Scares
Matthias Stuber , PhD; Aaron L. Baggish , MD
The ominous notion that coronavirus disease 2019 (COVID-19) is a disease of the heart emerged early during the global pandemic. Sentinel reports from the Wuhan region of China documented high prevalence rates of elevated plasma cardiac troponin levels with prognostic implications among critically ill patients hospitalized with COVID-19.1 In tandem, autopsy studies began to elucidate the pathologic features of COVID-19–associated myocardial injury, including diffuse interstitial macrophage infiltration, lymphocytic myocarditis, and microthrombosis.2,3 The possibility of COVID-19–associated myocarditis led to considerable concern in the general population and within segments of the population including competitive athletes, as malignant ventricular arrhythmia and sudden death are known complications of myocarditis. Expert consensus clinical decision algorithms for the general population, and broad-scale return-to-play screening recommendations for competitive athletes, were rapidly developed and broadly implemented.
First published: 6 February 2023