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Orbach A, Ghugre NR, Biswas L, Connelly KA, Chan A, Strauss BH, Wright GA, Roifman I. Low Prevalence of Late Myocardial Injury on Cardiac MRI Following COVID-19 Infection. J Magn Reson Imaging 2023; 58:1777-1784. [PMID: 36872614 DOI: 10.1002/jmri.28668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND The prevalence of abnormal cardiac magnetic resonance imaging (MRI) findings indicative of myocardial injury in patients who recovered from coronavirus disease 2019 (COVID-19) is currently unclear, with a high variability in the reported prevalence. PURPOSE To assess the prevalence of myocardial injury after a COVID-19 infection. STUDY TYPE Prospective, bicentric study. SUBJECTS Seventy consecutive patients who recovered from COVID-19 and were previously hospitalized. Mean age was 57 years and 39% of the patients were female. Ten healthy controls and a comparator group of 75 nonischemic cardiomyopathy (NICM) patients were employed. FIELD STRENGTH/SEQUENCE 1.5-T, steady-state free precession (SSFP) gradient-echo sequence, modified Look-Locker inversion recovery sequence with balanced SSFP readout, T2-prepared spiral readout sequence and a T1-weighted inversion recovery fast gradient-echo sequence was acquired ~4-5 months after recovery from COVID-19. ASSESSMENT The SSFP sequence was utilized for the calculation of left and right ventricular volumes and ejection fractions (LVEF and RVEF) following manual endocardial contouring. T1 and T2 mapping was performed by pixel-wise exponential fitting, and T1 and T2 values were computed by manual contouring of the left ventricular endocardial and epicardial walls. Late gadolinium enhancement (LGE) images were graded qualitatively as LGE present or absent. STATISTICAL TESTS T-tests and the χ2 or Fisher's exact tests were used to compare continuous and categorical variables respectively between the COVID-19 and NICM groups. Inter-rater agreement was evaluated by the intraclass correlation coefficient for continuous variables and Cohen's kappa test for LGE. RESULTS Reduced RVEF occurred in 10%, LGE and elevated native T1 in 9%, reduced LVEF in 4%, and elevated T2 in 3% of COVID-19 patients, respectively. Patients with NICM had lower mean LVEF (41.6% ± 6% vs. 60% ± 7%), RVEF (46% ± 5% vs. 61% ± 9%), and a significantly higher prevalence of LGE (27% vs. 9%) when compared to those post-COVID-19. DATA CONCLUSION Abnormal cardiac MRI findings may show a low prevalence in patients who recovered from COVID-19 and were previously hospitalized. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ady Orbach
- Schulich Heart Program, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | - Nilesh R Ghugre
- Schulich Heart Program, Sunnybrook Health Science Center, Toronto, Ontario, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Labonny Biswas
- Schulich Heart Program, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Adrienne Chan
- Division of Infectious Diseases, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Bradley H Strauss
- Schulich Heart Program, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | - Graham A Wright
- Schulich Heart Program, Sunnybrook Health Science Center, Toronto, Ontario, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Science Center, Toronto, Ontario, Canada
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Marques CA, Cabrita A, Araújo P, Proença T, Pinto R, Carvalho M, Costa C, Amador A, Calvão J, Cruz C. Acute myocardial infarction during late COVID-19 era: patient characteristics, presentation and outcomes. Monaldi Arch Chest Dis 2023; 93. [PMID: 36637356 DOI: 10.4081/monaldi.2023.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
COVID-19 pandemic has unquestionably influenced care of acute myocardial infarction (AMI). Still, its impact on patients (pts) characteristics, presentation, treatment, and outcomes remains not well established in late pandemic times. To address this issue, we performed a prospective study of type-1 AMI patients admitted in a tertiary care hospital. Pts were enrolled during 6-months in 2019 [n=122; pre-COVID-19 (PC) group] and in 2021 [n=196; late-COVID-19 (C) group]. Data was based on pts interview and review of medical records. Age and gender distribution, as well as ST/non-ST-elevation myocardial infarction (STEMI/NSTEMI) proportion and access to coronariography and revascularization were similar between groups. Group C patients presented more pre-existing established cardiovascular disease (CVD) (43% vs 30%; p=0.03); more frequent description of typical chest pain (94% vs 84%; p=0,002); higher levels of pain intensity, in a 0-10 scale (8±2 vs 7±2; p=0.02); higher frequencies of AMI complications (27% vs 15%; p=0.01) and worse Killip (K) class evolution (K≥2 in 22% C vs13% PC patients; p=0.05). In conclusion, late pandemic AMI patients presented worse in-hospital outcomes in our study, though pre-hospital and hospital care were comparable to pre-pandemic times. COVID patients had a higher burden of pre-existing established CVD and a more typical and intense symptom presentation. Therefore, it can be hypothesized that "sicker" patients continued to look for help when presenting AMI symptoms, while "less sick" patients and the ones with less typical and intense symptoms possibly avoided contact with health care services during late pandemic period.
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Affiliation(s)
| | - André Cabrita
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
| | - Paulo Araújo
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
| | - Tânia Proença
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
| | - Ricardo Pinto
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
| | - Miguel Carvalho
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
| | - Catarina Costa
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
| | - Ana Amador
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
| | - João Calvão
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
| | - Cristina Cruz
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto.
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Vidal-Perez R, Brandão M, Pazdernik M, Kresoja KP, Carpenito M, Maeda S, Casado-Arroyo R, Muscoli S, Pöss J, Fontes-Carvalho R, Vazquez-Rodriguez JM. Cardiovascular disease and COVID-19, a deadly combination: A review about direct and indirect impact of a pandemic. World J Clin Cases 2022; 10:9556-9572. [PMID: 36186196 PMCID: PMC9516905 DOI: 10.12998/wjcc.v10.i27.9556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is known to present with respiratory symptoms, which can lead to severe pneumonia and respiratory failure. However, it can have multisystem complications such as cardiovascular manifestations. The cardiovascular manifestations reported comprise myocarditis, cardiogenic shock, arrhythmias, pulmonary embolism, deep vein embolism, acute heart failure, and myocardial infarction. There is also an indirect impact of the pandemic on the management of cardiovascular care that has been shown clearly in multiple publications. In this review, we summarize the deadly relation of COVID-19 with cardiovascular events and the wider impact on several cardiovascular care areas by the pandemic situation
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Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
| | - Mariana Brandão
- Department of Cardiology, Centro Hospitalar de Gaia, Gaia 4400-020, Portugal
| | - Michal Pazdernik
- Intensive Care Unit, Department of Cardiology, Institute for Clinical and Experimental Medicine Prague, Prague 14021, Czech Republic
| | | | - Myriam Carpenito
- Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, Rome 00128, Italy
| | - Shingo Maeda
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kawasaki 210-0822, Japan
| | - Rubén Casado-Arroyo
- Department of Cardiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium
| | - Saverio Muscoli
- Unit of Cardiology, Policlinico Tor Vergata, Rome 00133, Italy
| | - Janine Pöss
- Heart Center Leipzig, University of Leipzig, Leipzig 04289, Germany
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Gaia, Gaia 4400-020, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto 4200-319, Portugal
| | - Jose Manuel Vazquez-Rodriguez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
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Tereshchenko LG, Bishop A, Fisher-Campbell N, Levene J, Morris CC, Patel H, Beeson E, Blank JA, Bradner JN, Coblens M, Corpron JW, Davison JM, Denny K, Earp MS, Florea S, Freeman H, Fuson O, Guillot FH, Haq KT, Kim M, Kolseth C, Krol O, Lin L, Litwin L, Malik A, Mitchell E, Mohapatra A, Mullen C, Nix CD, Oyeyemi A, Rutlen C, Tam AE, Van Buren I, Wallace J, Khan A. Risk of Cardiovascular Events After COVID-19. Am J Cardiol 2022; 179:102-109. [PMID: 35843735 PMCID: PMC9282909 DOI: 10.1016/j.amjcard.2022.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
We aimed to determine absolute and relative risks of either symptomatic or asymptomatic SARS-CoV-2 infection for late cardiovascular (CV) events and all-cause mortality. We conducted a retrospective double cohort study of patients with either symptomatic or asymptomatic SARS-CoV-2 infection (COVID-19+ cohort) and its documented absence (COVID-19- cohort). The study investigators drew a simple random sample of records from all patients under the Oregon Health & Science University Healthcare (n = 65,585), with available COVID-19 test results, performed March 1, 2020 to September 13, 2020. Exclusion criteria were age <18 years and no established Oregon Health & Science University care. The primary outcome was a composite of CV morbidity and mortality. All-cause mortality was the secondary outcome. The study population included 1,355 patients (mean age 48.7 ± 20.5 years; 770 women [57%], 977 White non-Hispanic [72%]; 1,072 ensured [79%]; 563 with CV disease history [42%]). During a median 6 months at risk, the primary composite outcome was observed in 38 of 319 patients who were COVID-19+ (12%) and 65 of 1,036 patients who were COVID-19- (6%). In the Cox regression, adjusted for demographics, health insurance, and reason for COVID-19 testing, SARS-CoV-2 infection was associated with the risk for primary composite outcome (hazard ratio 1.71, 95% confidence interval 1.06 to 2.78, p = 0.029). Inverse probability-weighted estimation, conditioned for 31 covariates, showed that for every patient who was COVID-19+, the average time to all-cause death was 65.5 days less than when all these patients were COVID-19-: average treatment effect on the treated -65.5 (95% confidence interval -125.4 to -5.61) days, p = 0.032. In conclusion, either symptomatic or asymptomatic SARS-CoV-2 infection is associated with an increased risk for late CV outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period.
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Affiliation(s)
- Larisa G Tereshchenko
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio.
| | - Adam Bishop
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Nora Fisher-Campbell
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jacqueline Levene
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Craig C Morris
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Hetal Patel
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; Chicago Medical School at Rosalind Franklin University, Chicago, Illinois
| | - Erynn Beeson
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jessica A Blank
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jg N Bradner
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Michelle Coblens
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jacob W Corpron
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jenna M Davison
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kathleen Denny
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Mary S Earp
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Simeon Florea
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Howard Freeman
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Olivia Fuson
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Florian H Guillot
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kazi T Haq
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Morris Kim
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Clinton Kolseth
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Olivia Krol
- Chicago Medical School at Rosalind Franklin University, Chicago, Illinois
| | - Lisa Lin
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Liat Litwin
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Aneeq Malik
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Evan Mitchell
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Aman Mohapatra
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; Chicago Medical School at Rosalind Franklin University, Chicago, Illinois
| | - Cassandra Mullen
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Chad D Nix
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ayodele Oyeyemi
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Christine Rutlen
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ashley E Tam
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Inga Van Buren
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jessica Wallace
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Akram Khan
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
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