Key result
COVID-19 hospitalization with elevated troponin shows no difference in inducible myocardial ischemia versus matched controls.
Why the study?
The pathophysiology of myocardial injury following COVID-19 remained uncertain.
Does recent hospitalization with COVID-19 and elevated troponin increase the frequency of inducible myocardial ischaemia compared to comorbid controls?
Observational (n=96)
Blinded analysis
Yes
Does recent hospitalization with COVID-19 and elevated troponin increase the frequency of inducible myocardial ischaemia compared to comorbid controls?
Absolute Event Rate: 18.6% vs 21.6%
p-value: p=0.722
Myocardial ischaemia occurs in about 20% of patients hospitalized with COVID-19 and elevated troponin, but at a similar rate to matched comorbid controls, suggesting it is not the primary mechanism of COVID-19 myocardial injury.
No excess inducible ischaemia after COVID hospitalization with troponin elevation versus controls; leaves open whether routine testing improves outcomes in this population.
The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin + , age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID -/comorbidity + , 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.
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Arnold et al. (2024) conducted an observational in COVID-19 with myocardial injury (n=96). COVID-19 hospitalization with elevated troponin vs. Matched subjects without COVID-19 or elevated troponin was evaluated on Frequency of inducible myocardial ischaemia (p=0.722). Hospitalization for COVID-19 with elevated troponin was associated with an 18.6% frequency of inducible myocardial ischaemia, which was not significantly different from the 21.6% observed in matched comorbid controls.
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