What is the clinical evidence from this study?

Study design: Case-Control. Population: COVID-19 (n=1285). Intervention: SARS-CoV-2 infection vs. No SARS-CoV-2 infection. Primary outcome: Longitudinal changes in cardiac and aortic imaging phenotypes.

November 5, 2021Open Access

Longitudinal Changes of Cardiac and Aortic Imaging Phenotypes Following COVID-19 in the UK Biobank Cohort

Key Result

Predominantly mild, non-hospitalized SARS-CoV-2 infection was not associated with significant longitudinal changes in cardiac or aortic imaging phenotypes compared to matched uninfected controls.

Study Design

Type

Case-Control (n=1,285)

Multicenter

Yes

Structured PICO

Does mild SARS-CoV-2 infection cause persistent longitudinal changes in cardiac and aortic imaging phenotypes in a general adult population?

Population

1,285 UK Biobank volunteers (mean age 59.8 years, 54.5% female) who underwent cardiac magnetic resonance imaging before and after the COVID-19 pandemic, including 640 with prior SARS-CoV-2 infection and 645 matched controls.

Exposure

SARS-CoV-2 infection (n=640), the majority of which were mild and did not involve hospitalization.

Comparator

Matched controls with no evidence of previous SARS-CoV-2 infection (n=645).

Outcome

Longitudinal changes in cardiac and aortic imaging phenotypes (structure and function) derived from CMR images before and after SARS-CoV-2 infection.surrogate

Mild, non-hospitalized SARS-CoV-2 infection is not associated with clinically significant persistent cardiac or aortic structural and functional changes on CMR when compared to pre-infection baseline imaging.

Limitations

Cardiac and aortic measurements were performed using fully automated image segmentation.
Population is limited to UK Biobank volunteers, which may not generalize to more severe cases of COVID-19.
Small number of hospitalized cases limits statistical power to detect differences in severe COVID-19.
Analyses only considered structural and functional CMR measures.

Abstract

Abstract Case studies conducted after recovery from acute infection with SARS-CoV-2 have frequently identified abnormalities on CMR imaging, suggesting the possibility that SARS-CoV-2 infection commonly leads to cardiac pathology. However, these observations have not been able to distinguish between associations that reflect pre-existing cardiac abnormalities (that might confer a greater likelihood of more severe infection) from those that arise as consequences of infection. To address this question, UK Biobank volunteers (n=1285; 54.5% women; mean age at baseline, 59.8 years old; 96.3% white) who attended an imaging assessment including cardiac magnetic resonance (CMR) before the start of the COVID-19 pandemic were invited to attend a second imaging assessment in 2021. Cases with evidence of previous SARS-CoV-2 infection were identified through linkage to PCR-testing or other medical records, or a positive antibody lateral flow test; n=640 in data available on 22 Sep 2021) and were matched to controls with no evidence of previous infection (n=645). The majority of these infections were milder and did not involve hospitalisation. Measures of cardiac and aortic structure and function were derived from the CMR images obtained on the cases before and after SARS-CoV-2 infection from images for the controls obtained over the same time interval using a previously validated, automated algorithm. Cases and controls had similar cardiac and aortic imaging phenotypes at their first imaging assessment. Changes between CMR imaging measures in cases before and after infection were not significantly different from those in the matched control group. Additional adjustment for comorbidities made no material difference to the results. While these results are preliminary and limited to imaging metrics derived from automated analyses, they do not suggest clinically significant persistent cardiac pathology in the UK Biobank population after generally milder (non-hospitalised) SARS-CoV-2 infection.

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