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Clinical Significance of Myocardial Injury in COVID-19 Survivors
Quick Takes
- COVID-19–related acute myocardial injury in hospital survivors with troponin elevation generally presents as self-limited in nature, with patients experiencing favorable medium-term cardiovascular outcomes.
- This is further evidenced by the low incidence of recurrent myocarditis and MACE, as well as the observed stability in biventricular structure and function.
- The near-universal resolution of pericardial and pleural effusions, along with lung changes, indicates that the inflammatory effects of COVID-19 are predominantly short-lived and nonprogressive.
Study Questions:
What is the progression and impact of myocardial injury on coronavirus disease 2019 (COVID-19) survivors?
Methods:
The COVID-HEART (COVID-19 Effects on the Heart) investigators conducted a prospective, longitudinal cohort study in 25 United Kingdom centers (from June 2020 to March 2021). Hospitalized COVID-19 patients with myocardial injury underwent cardiac magnetic resonance (CMR) scans within 28 days and 6 months post-discharge. Outcomes were tracked for 12 months, with quality-of-life surveys (EuroQol-5 Dimension and 36-Item Short Form surveys) taken at discharge and 6 months. For statistical comparisons, discrete variables were analyzed using either the chi-square test or Fisher exact test depending on the sample size and expected frequencies. Continuous variables were examined using the paired Student’s t-test if they followed a normal distribution or by the nonparametric Wilcoxon signed rank test if they did not.
Results:
Of 342 participants (median age, 61.3 years; 71.1% male) with baseline CMR, 338 had a 12-month follow-up, 235 had a 6-month CMR, and 215 had baseline and follow-up quality-of-life surveys. Of 338 participants, within 12 months, 1.2% died; 1.8% had new myocardial infarction, acute coronary syndrome, or coronary revascularization; 0.8% had new myopericarditis; and 3.3% had other cardiovascular events requiring hospitalization. At 6 months, there was a minor improvement in left ventricular ejection fraction (1.8% ± 1.0%; p < 0.001), stable right ventricular ejection fraction (0.4% ± 0.8%; p = 0.50), no change in myocardial scar pattern or volume (p = 0.26), and no imaging evidence of continued myocardial inflammation. All pericardial effusions (26 of 26) resolved, and most pneumonitis resolved (95 of 101). EuroQol-5 Dimension scores indicated an overall improvement in quality of life (p < 0.001).
Conclusions:
The authors report that myocardial injury in severe hospitalized COVID-19 survivors is nonprogressive and medium-term outcomes show a low incidence of major adverse cardiovascular events (MACE) and improved quality of life.
Perspective:
This study reports that COVID-19–related acute myocardial injury in hospital survivors with troponin elevation generally presents as self-limited in nature, with patients experiencing favorable medium-term cardiovascular outcomes. This is further evidenced by the low incidence of recurrent myocarditis and MACE, as well as the observed stability in biventricular structure and function. In addition, the near-universal resolution of pericardial and pleural effusions, along with lung changes, indicates that the inflammatory effects of COVID-19 are predominantly short-lived and nonprogressive. This study will help apprise public health strategies for health care resource allocation and follow-up programs for COVID-19 survivors with myocardial injury.
Clinical Topics: COVID-19 Hub, Noninvasive Imaging, Pericardial Disease, Magnetic Resonance Imaging, Cardiovascular Care Team
Keywords: COVID-19, Magnetic Resonance Imaging, Myocardial Infarction, Pericardial Effusion, Quality of Life, Troponin
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