Cardiac Involvement, Ongoing Myocardial Inflammation Observed After Recent COVID-19 Recovery

A large percentage of patients who recently recover from coronavirus disease 2019 (COVID-19) were found to have cardiac involvement and ongoing myocardial inflammation, according to a study published in JAMA Cardiology.

The prospective observational study included 100 patients (median age, 49 years) in the University Hospital Frankfurt COVID-19 Registry in Germany who were diagnosed with and recovered from the severe acute respiratory syndrome coronavirus 2 and identified between April and June 2020.

In this cohort, cardiac magnetic resonance imaging (MRI) was performed, and levels of cardiac blood markers, including high-sensitivity C-reactive protein (CRP), high-sensitivity troponin T (hsTnT), and N-terminal pro–b-type natriuretic peptide (NT-proBNP) were measured. Data from patients recovered from COVID-19 and age- and sex-matched control normotensive healthy volunteers (n=50) and risk factor–matched patients (n=57) were compared.

The overall median duration between the COVID-19 diagnosis and the performance of a cardiac MRI was 71 days. A total of 67% of the study population recovered from COVID-19 at home, and the remaining 33% of patients required hospitalization.

Detectable hsTnT (ie, ≥3 pg/mL) was found in 71 patients at time of cardiac MRI, with elevations to ≥13.9 pg/mL in 5 of those patients. On the day of cardiac MRI, patients who had recently recovered from COVID-19 had, compared with healthy control individuals: lower left ventricular ejection fraction (56 vs 60%, respectively; P <.001), higher left ventricular mass (51 vs 47 g/m², respectively; P =.001), and increased native T1 (1130 vs 1077 ms, respectively; P <.001) and T2 (39 vs 35 ms, respectively; P <.001).

Patients who recently recovered from COVID-19 had, compared with risk factor-matched controls and healthy control individuals: higher high-sensitivity CRP (0.24 vs 0.12 vs 0.11 mg/dL, respectively; P <.001), hsTnT (5.6 vs 3.9 vs 3.2 pg/mL, respectively; P <.001), detectable hsTnT (71 vs 31 vs 11 pg/mL, respectively; P <.001), and NT-proBNP (69 vs 58 vs 48 pg/mL, respectively; P =.02).

Abnormal cardiac MRI findings were observed in 78% of patients recently recovered from COVID-19. Abnormalities included increased myocardial native T1 (n=73), raised myocardial native T2 (n=60), myocardial late gadolinium enhancement (n=32), and pericardial enhancement (n=22).

A significant yet small difference was observed between patients who recovered from COVID-19 at home vs those who recovered in the hospital in terms of native T1 mapping (median, 1122 vs 1143 ms, respectively; P =.02). There were significant correlations between hsTnT and native T1 mapping (r = 0.35; P <.001) and between hsTnT and native T2 mapping (r = 0.22; P =.03).

Active lymphocytic inflammation with no evidence of viral genome was detected in endomyocardial biopsies of patients with severe findings. The measures with the best discriminatory ability to detect myocardial pathology related to COVID-19 were native T1 and T2.

Limitations of this study include the lack of asymptomatic patients with COVID-19 in the cohort.

“These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19,” noted the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19) [published online July 27, 2020]. JAMA Cardiol. doi:10.1001/jamacardio.2020.3557