WASHINGTON: A recent study showed that about 50 percent of patients, who are hospitalized because of Covid-19 symptoms, show high levels of a protein called troponin that causes damage to their hearts. .
The injury was detected by magnetic resonance imaging (MRI) scans at least a month after their release, according to new results published today (Thursday) in the European Heart Journal
Damage includes inflammation of the heart muscle (myocarditis), scarring or death of a heart attack (infarction), a restricted blood supply to the heart (ischemia) and a combination of all three.
A study of 148 patients from six London emergency hospitals is the largest study to date to examine Covid-19 patients who had elevated troponin levels revealing a potential heart problem .
Troponin is released into the bloodstream when the heart muscle is injured. Elevated levels can occur when an artery is blocked or there is inflammation in the heart. Many hospitalized patients with Covid-19 have elevated troponin levels at the stage of the acute illness when the body puts up an immune response to the disease. Troponin levels were elevated in all patients in this study followed by MRI scans of the heart after discharge to understand the causes and extent of the damage.
Professor Marianna Fontana, a professor of cartography at University College London (UK), who led the research with Dr Graham Cole, a consultant cardiologist at Imperial College London, said: “Elevated troponin levels co -connected with worse outcomes in Covid-19 patients. Patients with severe Covid-19 disease often have heart-related health problems including diabetes, elevated blood pressure, and obesity. ”
“But in severe Covid-19 disease, however, it can have a direct effect on the heart. It’s hard to know how the heart could be damaged, but MRI scans of the heart can identify different patterns of injury, which may allow us to make more accurate diagnoses and focus on more effective treatments, “Fontana said.
The researchers studied Covid-19 patients discharged up to June 2020 from six hospitals across three London NHS trusts: London Free NHS Foundation Trust, Imperial College Healthcare NHS Trust, and NHS Foundation Trust University College London Hospital.
An MRI scan of the heart was offered to patients with abnormal troponin levels after discharge and compared with those from a control group of patients not on Covid-19, as well as from 40 healthy volunteers.
“The recovering Covid-19 patients were very ill; they all needed hospitalization and all had a troponin booster, with about one in three having been on an airway in the intensive care unit, “said Dr. Fontana.
“We found evidence of high levels of heart muscle injury seen on the scans a month or two after discharge. While some of this may have occurred before, an MRI scan shows that some of them new, and apparently caused by Covid- 19. Importantly, the pattern of heart damage was variable, suggesting that the heart is at risk from various types of injuries.While we found only very small number of persistent injuries, we saw heart injuries that were present even when heart pumping was unobstructed and may not have been picked up by other means.In the worst cases, there are concerns that the injury may These increase the risks of heart failure in the future, but more work is needed to investigate this further. ”
The left ventricle function of the heart, the chamber responsible for pumping oxygenated blood to all parts of the body, was normal in 89 percent of the 148 patients but heart muscle rupture or injury was present in 80 patients (54 per cent). The pattern of scarring or thin lesions arose from inflammation in 39 patients (26 percent), ischemic heart disease, which includes infarction or ischemia, in 32 patients (22 percent), or both in nine patients (6 percent). A dozen patients appeared to have persistent heart inflammation (8 percent).
Dr. said. Fontana: “Inflammation-related injury and scarring of the heart are common in Covid-19 patients with elevated troponin discharge from hospital, but it is mild and has little effect on the functioning of the heart. heart.
“These decisions give us two opportunities: first, to find ways to prevent the injury in the first place, and from some of the patterns we have seen, bloodshed may be role play, which we may have possible cures. Second, it found that the effects of injury during recovery may identify subjects who would benefit from specific drug supportive therapies to protect heart activity over time. ”
The findings of the study are limited by the nature of patient selection and included only those who survived coronavirus infection who required hospital admission.
“The convalescent patients in this study had very severe Covid-19 infection and our results say nothing about what happens to people who are not hospitalized with Covid or to those who are hospitalized but without elevated troponin. the findings highlight ways in which patients may be identified at a higher or lower risk and suggest strategies that may improve outcomes.More work is needed, and MRI scans of the heart has shown its usefulness in the study of patients with troponin elevation, “concluded Dr. Fontana.
The injury was detected by magnetic resonance imaging (MRI) scans at least a month after their release, according to new results published today (Thursday) in the European Heart Journal
Damage includes inflammation of the heart muscle (myocarditis), scarring or death of a heart attack (infarction), a restricted blood supply to the heart (ischemia) and a combination of all three.
A study of 148 patients from six London emergency hospitals is the largest study to date to examine Covid-19 patients who had elevated troponin levels revealing a potential heart problem .
Troponin is released into the bloodstream when the heart muscle is injured. Elevated levels can occur when an artery is blocked or there is inflammation in the heart. Many hospitalized patients with Covid-19 have elevated troponin levels at the stage of the acute illness when the body puts up an immune response to the disease. Troponin levels were elevated in all patients in this study followed by MRI scans of the heart after discharge to understand the causes and extent of the damage.
Professor Marianna Fontana, a professor of cartography at University College London (UK), who led the research with Dr Graham Cole, a consultant cardiologist at Imperial College London, said: “Elevated troponin levels co -connected with worse outcomes in Covid-19 patients. Patients with severe Covid-19 disease often have heart-related health problems including diabetes, elevated blood pressure, and obesity. ”
“But in severe Covid-19 disease, however, it can have a direct effect on the heart. It’s hard to know how the heart could be damaged, but MRI scans of the heart can identify different patterns of injury, which may allow us to make more accurate diagnoses and focus on more effective treatments, “Fontana said.
The researchers studied Covid-19 patients discharged up to June 2020 from six hospitals across three London NHS trusts: London Free NHS Foundation Trust, Imperial College Healthcare NHS Trust, and NHS Foundation Trust University College London Hospital.
An MRI scan of the heart was offered to patients with abnormal troponin levels after discharge and compared with those from a control group of patients not on Covid-19, as well as from 40 healthy volunteers.
“The recovering Covid-19 patients were very ill; they all needed hospitalization and all had a troponin booster, with about one in three having been on an airway in the intensive care unit, “said Dr. Fontana.
“We found evidence of high levels of heart muscle injury seen on the scans a month or two after discharge. While some of this may have occurred before, an MRI scan shows that some of them new, and apparently caused by Covid- 19. Importantly, the pattern of heart damage was variable, suggesting that the heart is at risk from various types of injuries.While we found only very small number of persistent injuries, we saw heart injuries that were present even when heart pumping was unobstructed and may not have been picked up by other means.In the worst cases, there are concerns that the injury may These increase the risks of heart failure in the future, but more work is needed to investigate this further. ”
The left ventricle function of the heart, the chamber responsible for pumping oxygenated blood to all parts of the body, was normal in 89 percent of the 148 patients but heart muscle rupture or injury was present in 80 patients (54 per cent). The pattern of scarring or thin lesions arose from inflammation in 39 patients (26 percent), ischemic heart disease, which includes infarction or ischemia, in 32 patients (22 percent), or both in nine patients (6 percent). A dozen patients appeared to have persistent heart inflammation (8 percent).
Dr. said. Fontana: “Inflammation-related injury and scarring of the heart are common in Covid-19 patients with elevated troponin discharge from hospital, but it is mild and has little effect on the functioning of the heart. heart.
“These decisions give us two opportunities: first, to find ways to prevent the injury in the first place, and from some of the patterns we have seen, bloodshed may be role play, which we may have possible cures. Second, it found that the effects of injury during recovery may identify subjects who would benefit from specific drug supportive therapies to protect heart activity over time. ”
The findings of the study are limited by the nature of patient selection and included only those who survived coronavirus infection who required hospital admission.
“The convalescent patients in this study had very severe Covid-19 infection and our results say nothing about what happens to people who are not hospitalized with Covid or to those who are hospitalized but without elevated troponin. the findings highlight ways in which patients may be identified at a higher or lower risk and suggest strategies that may improve outcomes.More work is needed, and MRI scans of the heart has shown its usefulness in the study of patients with troponin elevation, “concluded Dr. Fontana.