Cardiac Impairment by MRI in Long COVID Predicts Persisting Symptoms

Janelle Blankenship, PharmD, for Medscape

April 25, 2022

The study covered in this summary was published on MedRxiv.org as a preprint and has not yet been peer-reviewed.

Key Takeaways

  • Cardiac impairment, imaging-confirmed and usually unrelated to myocarditis, was observed at 6 months in 19% of patients with persistently symptomatic COVID-19; about 60% of those patients showed cardiac impairment at 12 months.

  • Hospitalization with acute COVID-19 did not predict future cardiac impairment, nor did laboratory cardiac biomarkers or symptoms.

  • Certain cardiac MRI (CMR) findings at 6 months predicted symptom severity and quality of life at 12 months; they included lower left ventricular ejection fraction (LVEF), low global longitudinal strain (GLS), and elevated myocardial T1.

Why This Matters

  • There is currently a lack of information on cardiac impairment in patients with long COVID-19.

  • This study assessed cardiac impairment in patients with long COVID-19 over 12 months, the longest such follow-up to date.

Study Design

  • The prospective cohort study involved 534 patients with laboratory-confirmed or clinically diagnosed COVID-19 who were assessed at centers in the United Kingdom between May 2020 and August 2021.

  • They were clinically evaluated and underwent multiorgan MRI; reference ranges were determined from 92 healthy age-matched control subjects.

  • Quality of life, symptoms, and left ventricular function were assessed using the EQ-5D-5L, Dyspnea-12, and LVD-36 questionnaires.

Key Results

  • At 6 months after their first symptoms of COVID-19 symptoms, cardiac biomarkers were elevated in six patients (1.1%), of whom only one showed cardiac impairment by CMR.

  • Such cardiac impairment was evident in 101 patients (19%) among those with normal cardiac biomarker levels.

  • Cardiac impairment at 6 months primarily consisted of elevated T1 (45%), reduced LVEF (21%), reduced right ventricular ejection fraction (21%), and low GLS (21%).

  • Most patients with cardiac impairment (81%) had not been hospitalized with COVID-19.

  • Of those with cardiac impairment, 41% were male, compared with 24% of those without cardiac impairment (P = .001).

  • Follow-up data were available for 71 of the 102 patients who had cardiac impairment at 6 months. Of those, 42% showed resolution of cardiac impairment at 12 months; such impairment persisted in the remaining 58%.

  • Ten people with normal cardiac function at 6 months had developed new cardiac impairment at 12 months.

  • Of those with cardiac impairment at 6 months, 62% reported severe COVID-19 symptoms.

  • At 12 months, 43% of patients with resolved cardiac impairment and 39% with ongoing cardiac impairment self-reported severe long COVID-19 symptoms.

  • Low LVEF was associated with persistent cardiac impairment at 12 months (P = .03).

  • Low GLS at 6 months was associated with poor quality of life at 12 months (odds ratio [OR], 0.78; 95% CI, 0.67 - 0.91; P = .001).

  • Elevated cardiac T1 on three or more segments at 6 months was associated with lower symptom severity at 12 months (OR, 0.71; 95% CI, 0.52 - 0.96; P = .02).

Limitations

  • Cardiac impairment was assessed by native T1 mapping to avoid potential complications from gadolinium contrast in patients with COVID-19 renal involvement.

  • Individuals without cardiac impairment at baseline did not have follow-up scans.

  • No pre-COVID imaging results were available.

  • Although COVID-19 disproportionately affects non-White individuals, White individuals accounted for 89% of the included patients.

  • Further research is needed to identify appropriate therapeutic options for patients with long COVID-19 and cardiac impairment.

Disclosures

  • This study was funded in part by an Amendment to a European Commission’s Horizon 2020 grant 719445, Non-Invasive Rapid Assessment of Chronic Liver Disease Using Magnetic Resonance Imaging with Liver MultiScan (RADIcAL).

  • One author received funding from NIHR, AstraZeneca, the European Union, UK Research and Innovation, and British Medical Association. Numerous authors are employees of Perspectum.

This is a summary of a preprint research study, Cardiac Impairment in Long Covid 1-Year Post-SARS-CoV-2 Infection, written by Adriana Roca-Fernández from Perspectum Ltd, Oxford, United Kingdom, and colleagues on MedRxiv.org, provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on MedRxiv.org.

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