Cardiac Pathology 6 Months after Hospitalization for COVID-19 and Association with the Acute Disease Severity: Cardiac MRI 6 months after COVID-19

Myhre, Peder L.; Heck, Siri L.; Skranes, Julia B.; Prebensen, Christian; Jonassen, Christine M.; Berge, Trygve; Mecinaj, Albulena; Melles, Woldegabriel; Einvik, Gunnar; Ingul, Charlotte B.; Tveit, Arnljot; Berdal, Jan Erik; Røsjø, Helge; Lyngbakken, Magnus N.; Omland, Torbjørn

BACKGROUND: COVID-19 may cause myocardial injury and myocarditis, and reports of persistent cardiac pathology after COVID-19 have raised concerns of long-term cardiac consequences. We aimed to assess the presence of abnormal cardiovascular resonance imaging (CMR) findings in patients recovered from moderate-to-severe COVID-19, and its association with markers of disease severity in the acute phase. METHODS: Fifty-eight (49%) survivors from the prospective COVID MECH study, underwent CMR median 175 [IQR 105-217] days after COVID-19 hospitalization. Abnormal CMR was defined as left ventricular ejection fraction (LVEF) <50% or myocardial scar by late gadolinium enhancement. CMR indices were compared to healthy controls (n=32), and to circulating biomarkers measured during the index hospitalization. RESULTS: Abnormal CMR was present in 12 (21%) patients, of whom three were classified with major pathology (scar and LVEF<50% or LVEF<40%). There was no difference in the need of mechanical ventilation, length of hospital stay, and vital signs between patients with versus without abnormal CMR after 6 months. SARS-CoV-2 viremia and concentrations of inflammatory biomarkers were not associated with persistent CMR pathology. Cardiac troponin T and N-terminal pro-B-type natriuretic peptide concentrations on admission, were higher in patients with CMR pathology, but these associations were not significant after adjusting for demographics and established cardiovascular disease. CONCLUSIONS: CMR pathology 6 months after moderate-to-severe COVID-19 was present in 21% of patients and did not correlate with severity of the disease. Cardiovascular biomarkers during COVID-19 were higher in patients with CMR pathology, but with no significant association after adjusting for confounders. TRIAL REGISTRATION: COVID MECH Study ClinicalTrials.gov Identifier: NCT04314232