Demographic, multi-morbidity and genetic impact on myocardial involvement and its recovery from COVID-19: protocol design of COVID-HEART—a UK, multicentre, observational study

Abstract

Background Although coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, myocardial injury is increasingly reported and associated with adverse outcomes. However, the pathophysiology, extent of myocardial injury and clinical significance remains unclear. Methods COVID-HEART is a UK, multicentre, prospective, observational, longitudinal cohort study of patients with confirmed COVID-19 and elevated troponin (sex-specific > 99th centile). Baseline assessment will be whilst recovering in-hospital or recently discharged, and include cardiovascular magnetic resonance (CMR) imaging, quality of life (QoL) assessments, electrocardiogram (ECG), serum biomarkers and genetics. Assessment at 6-months includes repeat CMR, QoL assessments and 6-min walk test (6MWT). The CMR protocol includes cine imaging, T1/T2 mapping, aortic distensibility, late gadolinium enhancement (LGE), and adenosine stress myocardial perfusion imaging in selected patients. The main objectives of the study are to: (1) characterise the extent and nature of myocardial involvement in COVID-19 patients with an elevated troponin, (2) assess how cardiac involvement and clinical outcome associate with recognised risk factors for mortality (age, sex, ethnicity and comorbidities) and genetic factors, (3) evaluate if differences in myocardial recovery at 6 months are dependent on demographics, genetics and comorbidities, (4) understand the impact of recovery status at 6 months on patient-reported QoL and functional capacity. Discussion COVID-HEART will provide detailed characterisation of cardiac involvement, and its repair and recovery in relation to comorbidity, genetics, patient-reported QoL measures and functional capacity. Clinical Trial registration: ISRCTN 58667920. Registered 04 August 2020.

A multisystem, cardio-renal investigation of post-COVID-19 illness

“…Troponin elevation was not an eligibility criterion, and renal dysfunction was not an exclusion criterion. Our study design stands apart from previous studies that involved selected populations (COVID-HEART 35 and COVIDsortium 36 ), retrospective case selection 19 , 20 or a sample size limiting generalizable conclusions 12 . In a cardiac screening study of 789 North American professional athletes who had tested positive for COVID-19, cardiac abnormalities were uncommon (3.8%) and myo-pericarditis was identified in 0.6% of individuals, without adverse cardiac events 37 .…”

Repolarization abnormalities on admission predict 1-year outcome in COVID-19 patients

“…The true long-term cardiovascular outcome after COVID-19 should preferably be assessed with prospective, observational, longitudinal cohort studies. An excellent example is the COVID-HEART study which is a multi-center study including patients with confirmed COVID-19 and elevated troponin levels [23] . Baseline assessment in the COVID-HEART study will include cardiac magnetic resonance imaging, serial ECG, biomarkers, genetics and quality of life assessment.…”

Progressive myocardial dysfunction following COVID-19

“…He underwent cardiovascular magnetic resonance (CMR) imaging as part of a UK, multicentre, Urgent Public Health research study (ISRCTN58667920). 1 CMR revealed mild impairment in left ventricular ejection fraction (LVEF 45%).Stress perfusion CMR revealed no inducible ischaemia, whereas late gadolinium enhancement images showed patchy mid-wall hyperenhancement consistent with COVID-19 myocarditis ( figure 1A ). T1-mapping confirmed myocardial injury in a non-ischaemic pattern ( figure 1B ) and global myocardial T2 was also elevated consistent with acute inflammation ( figure 1C ).…”