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Heart damage seen in more than half of discharged COVID-19 patients

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退院したCOVID-19患者の半数以上に見られる心臓の損傷

MRI scan of the injured heart. Blue means reduced blood flow and orange means good blood flow. In this figure, the lower part of the heart is shown in dark blue, which greatly reduces blood flow in the myocardium, and a black-and-white angiography that looks directly at the blood vessels shows the blood vessels that supply blood to this part of the heart. I am. It is blocked. The three color images are three different slices of the heart. The basal slice and the apex slice. credit: European Heart Journal

Approximately 50% of patients who are hospitalized with severe COVID-19 and have elevated levels of a protein called troponin have heart damage. Injuries were detected by magnetic resonance imaging (MRI) scans at least one month after discharge, according to new findings released today. European Heart Journal..

Inflammation includes inflammation Muscle (myocarditis), scarring or death of heart tissue (infarction), restriction For the heart (ischemia) and all three combinations.

148 studies Studies from six acute hospitals in London are the largest studies to date to investigate the recovery of patients with COVID-19 who have elevated troponin levels that may indicate heart problems.

Troponin is released into the blood when the heart muscle is damaged. Elevated levels can occur when arteries are occluded or the heart is inflamed. Many patients hospitalized with COVID-19 have elevated troponin levels at the stage of serious illness when the body initiates an exaggerated immune response to infection. Troponin levels were elevated in all patients in this study, after which an MRI scan of the heart was followed after discharge to understand the cause and extent of the injury.

Marianna Fontana, a professor of cardiology at University College London (UK), who led the study with Dr. Graham Cole, a cardiologist at Imperial College London, said: “Elevated troponin levels are associated with worse outcomes in COVID-19 patients. Patients with severe COVID-19 infections have pre-existing heart-related health issues such as diabetes, elevated blood pressure, and obesity. Often there are problems. However, during severe COVID-19 infections, the heart can also be directly affected. Although damage is difficult, MRI scans of the heart can identify different patterns. This may allow you to make a more accurate diagnosis and target your treatment more effectively. “

Researchers found COVID-19 patients discharged from six hospitals by June 2020: three NHS London Trusts (Royal Free London NHS Foundation Trust, Imperial College Healthcare NHS Trust, University College London Hospital NHS Foundation Trust) Was investigated. Patients with abnormal troponin levels were provided with an MRI scan of the heart after discharge and compared to patients from the control group of patients who did not have COVID-19, and patients from 40 healthy volunteers. I did.

“The recovering COVID-19 patients were very ill. All required hospitalization, all had elevated troponin, and one in three used a ventilator in the intensive care unit.” Professor Fontana said.

“We found evidence of a high rate of myocardial damage that could be seen on scans a month or two after discharge. Some of this may have been existing, but some MRI scans. Is new and probably caused by COVID- 19. Importantly, the patterns of damage to the heart vary, suggesting that the heart is at risk of different types of damage. The damage in progress was negligible, but the damage to the heart was not impaired in the heart’s pumping function and may not have been detected by other techniques. In the most serious cases. There is concern that this injury may increase the risk of future heart failure, but more work is needed to investigate this further.

The function of the left ventricle of the heart, the ventricle responsible for pumping oxygenated blood to all parts of the body, was normal in 89% of 148 patients, but myocardium in 80 patients (54%). Scaring or damage was seen. .. The pattern of tissue scarring or damage is ischemic heart disease, including inflammation, infarction or ischemia in 39 patients (26%), 32 patients (22%), or 9 patients (6%). Due to both. Twelve patients (8%) appeared to have ongoing cardiac inflammation.

Professor Fontana said: “Inflammation and scarring-related injuries to the heart are common in COVID-19 patients with elevated troponin discharged from the hospital, but to a limited extent and have little effect on heart function.

“These discoveries give us two opportunities. One is to find a way to prevent injuries first, and from some of the patterns we have seen, blood clotting plays a role. There is potential and potential treatments for it. The consequences of convalescent injuries may identify subjects who will benefit from certain adjuvant treatments to protect heart function over the long term. not.”

The results of this study were limited by the nature of the patient’s choice and included only those who survived a coronavirus infection that required hospitalization.

“The convalescent patients in this study have severe COVID-19 disease and nothing about what happens to those who are not hospitalized with COVID or who are hospitalized but have no elevated troponin. The findings show potential ways to identify higher patients or suggest potential strategies that may reduce risk and improve results. More work is done. Required and MRI scans of the heart show how useful it is in investigating patients. “Elevation,” concludes Professor Fontana.

This study is also the subject of the first discussion between Professor Fontana and Professor Eike Nagel at the Annual Meeting of the Cardiovascular Magnetic Resonance Society on Friday, February 19th. Professor Nagel, director of the Cardiovascular Imaging Center at Deutsches Zentrum Für Herz-Kreislauf-Forschung (DZHK) in Frankfurt, Germany, is the lead author of a previous paper that found ongoing heart problems in up to 78% of COVID-19. .. Patients with few illnesses and most did not require hospitalization.


How does the coronavirus affect the heart?


For more information:
“Pattern of Myocardial Injury in Recovered Troponin-Positive COVID-19 Patients Assessed by Cardiovascular Magnetic Resonance”, European Heart Journal (2021). DOI: 10.1093 / eurheartj / ehab075

Valentina O. Puntmann et al. Results of cardiovascular magnetic resonance imaging in patients who recently recovered from coronavirus disease 2019 (COVID-19), JAMA Cardiology (2020). DOI: 10.1001 / jamacardio.2020.3557

Quote: Heart damage found in more than half of COVID-19 patients discharged from the hospital (February 18, 2021) can be found at https://medicalxpress.com/news/2021-02-heart-covid-patients-charged Obtained on February 18, 2021-hospital.html

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