About 50 percent of patients who have been hospitalized with Covid-19 grave and showing elevated levels of a protein called troponin have damage to the heart. The lesion was detected by magnetic resonance imaging (MRI) at least one month after discharge, according to new findings published in European Heart Journal. This damage includes myocarditis, infarction and ischemia and combinations of all three.
The study of 148 patients from six acute care hospitals in London is the largest study to date to investigate convalescent Covid-19 patients who had elevated troponin levels indicating a possible problem with the heart.
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The Elevated levels of troponin can occur when an artery becomes blocked or there is inflammation of the heart. Many hospitalized Covid-19 patients have elevated troponin levels during the critical phase of the disease, when the body generates an exaggerated immune response to the infection.
Troponin levels were elevated in all patients in this study, who underwent a follow-up with MRI of the heart after discharge to understand the causes and extent of damage.
In severe Covid infection, the heart can be directly affected
Marianna Fontana, Professor of Cardiology at University College London, in the United Kingdom, who led the research together with the Graham Cole, a consultant cardiologist at Imperial College London notes that “elevated levels of troponin are associated with worse outcomes in Covid-19 patients.”
“The heart is at risk for different types of injuries”
“Patients with severe illness due to Covid-19 often have pre-existing health problems related to the heart, such as diabetes, high blood pressure and obesity – he continues -. However, during a serious infection by Covid-19, the heart can also be directly affected. Deciphering how the heart can be damaged is difficult, but MRIs can identify different patterns of injury, which can allow us to make more accurate diagnoses and target treatments more effectively. “
The team investigated Covid-19 patients discharged through June 2020 from six hospitals in three London NHS trusts. The patients who had abnormal levels of troponin were offered an MRI of the heart after discharge and compared with those in a control group of patients who had not had Covid-19, as well as 40 healthy volunteers. “Recovering Covid-19 Patients Had Been Very Sick; all required hospitalization and all had elevated troponin levels, and about one in three had been on a ventilator in the intensive care unit, “Fontana says.
“We find evidence of high rates of heart muscle injury that could be seen on scans one to two months after discharge -Add-. While some of this may have been pre-existing, the MRI scan shows that some were new and likely caused by Covid-19. “
The pattern of damage to the heart was variable
Fontana notes that “It is important to note that the pattern of damage to the heart was variable, which suggests that the heart is at risk for different types of injuries. While we detected only a small number of ongoing injuries, we did see an injury to the heart that was present even when the heart’s pumping function was unaffected and might not have been detected by other techniques. In the most severe cases, there is concern that this injury could increase the risks of heart failure in the future, but more work is needed to investigate this further, “he acknowledges.
The function of the heart’s left ventricle, the chamber that is responsible for pumping oxygenated blood to all parts of the body, was normal in 89 percent of the 148 patients, but there were scarring or injury to the heart muscle in 80 patients (54 percent). The pattern of tissue healing or injury was caused by inflammation in 39 patients (26 percent), ischemic heart disease, including heart attack or ischemia, in 32 patients (22 percent), or both in nine patients (six percent). Twelve patients (eight percent) appeared to have ongoing heart inflammation.
Professor Fontana points out that “injuries related to inflammation and scarring of the heart are common in troponin-elevated Covid-19 patients discharged from the hospital, but are of limited extent and have little consequence for heart function. “He also highlights that” these findings provide two opportunities: first, to find ways to prevent injury in the first place, and from some of the patterns we’ve seen, the blood clotting may be playing a rolel, for which we have potential treatments. Second, “he continues,” detecting the consequences of injury during convalescence can identify subjects who would benefit from specific supportive pharmacological treatments to protect cardiac function over time. “
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