Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection

Adriana Roca-Fernandez; Malgorzata Wamil; Alison Telford; Valentina Carapella; Alessandra Borlotti; David Monteiro; Helena Thomaides-Brears; Matt Kelly; Andrea Dennis; Rajarshi Banerjee; Matthew Robson; Michael Brady; Gregory Y H Lip; Sacha Bull; Melissa Heightman; Ntobeko Ntusi; Amitava Banerjee

doi:10.1136/openhrt-2022-002241

Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection

Open Heart. 2023 Feb;10(1):e002241. doi: 10.1136/openhrt-2022-002241.

Authors

Adriana Roca-Fernandez¹, Malgorzata Wamil^{2

3}, Alison Telford¹, Valentina Carapella¹, Alessandra Borlotti¹, David Monteiro¹, Helena Thomaides-Brears¹, Matt Kelly¹, Andrea Dennis¹, Rajarshi Banerjee¹, Matthew Robson¹, Michael Brady¹, Gregory Y H Lip⁴, Sacha Bull⁵, Melissa Heightman⁶, Ntobeko Ntusi⁷, Amitava Banerjee^{8

9

10}

Affiliations

¹ Perspectum Ltd, Oxford, UK.
² Department of Cardiology, Great Western Hospital Foundation NHS Trust, Swindon, UK.
³ Department of Cardiology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK.
⁴ Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.
⁵ Department of Cardiology, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK.
⁶ Department of Respiratory Medicine, University College London Hospitals NHS Trust, London, UK.
⁷ Medicine, University of Cape Town, Cape Town, South Africa.
⁸ Institute of Health Informatics, University College London, London, UK ami.banerjee@ucl.ac.uk.
⁹ Department of Cardiology, University College London Hospitals NHS Trust, London, UK.
¹⁰ Department of Cardiology, Barts Health NHS Trust, London, UK.

Abstract

Background: Long COVID is associated with multiple symptoms and impairment in multiple organs. Cross-sectional studies have reported cardiac impairment to varying degrees by varying methodologies. Using cardiac MR (CMR), we investigated a 12-month trajectory of abnormalities in Long COVID.

Objectives: To investigate cardiac abnormalities 1-year post-SARS-CoV-2 infection.

Methods: 534 individuals with Long COVID underwent CMR (T1/T2 mapping, cardiac mass, volumes, function and strain) and multiorgan MRI at 6 months (IQR 4.3-7.3) since first post-COVID-19 symptoms. 330 were rescanned at 12.6 (IQR 11.4-14.2) months if abnormal baseline findings were reported. Symptoms, questionnaires and blood samples were collected at both time points. CMR abnormalities were defined as ≥1 of low left or right ventricular ejection fraction (LVEF), high left or right ventricular end diastolic volume, low 3D left ventricular global longitudinal strain (GLS), or elevated native T1 in ≥3 cardiac segments. Significant change over time was reported by comparison with 92 healthy controls.

Results: Technical success of multiorgan and CMR assessment in non-acute settings was 99.1% and 99.6% at baseline, and 98.3% and 98.8% at follow-up. Of individuals with Long COVID, 102/534 (19%) had CMR abnormalities at baseline; 71/102 had complete paired data at 12 months. Of those, 58% presented with ongoing CMR abnormalities at 12 months. High sensitivity cardiac troponin I and B-type natriuretic peptide were not predictive of CMR findings, symptoms or clinical outcomes. At baseline, low LVEF was associated with persistent CMR abnormality, abnormal GLS associated with low quality of life and abnormal T1 in at least three segments was associated with better clinical outcomes at 12 months.

Conclusion: CMR abnormalities (left entricular or right ventricular dysfunction/dilatation and/or abnormal T1mapping), occurred in one in five individuals with Long COVID at 6 months, persisting in over half of those at 12 months. Cardiac-related blood biomarkers could not identify CMR abnormalities in Long COVID.

Trial registration number: NCT04369807.

Keywords: COVID-19; EPIDEMIOLOGY; Magnetic Resonance Imaging; Myocarditis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Cross-Sectional Studies
Humans
Post-Acute COVID-19 Syndrome
Predictive Value of Tests
Quality of Life
SARS-CoV-2
Stroke Volume
Ventricular Function, Right

Associated data

ClinicalTrials.gov/NCT04369807