What is the damage to the heart after a serious Covid-19


About 50% of patients who have been hospitalized with severe COVID-19 and who show elevated levels of a protein called troponin have heart damage. The lesion was detected by magnetic resonance imaging (MRI) at least one month after discharge, according to new findings published in the ‘European Heart Journal’.

Damage includes inflammation of the heart muscle (myocarditis), scarring or death of heart tissue (infarction), restriction of blood supply to the heart (ischemia), and combinations of the 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.

Troponin is released into the blood when the heart muscle is injured. Elevated levels 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 infection. Troponin levels were elevated in all patients in this study, who were followed up with MRIs of the heart after discharge to understand the causes and extent of damage.

Professor Marianna Fontana, a professor of cardiology at University College London, UK, who led the research together with Dr Graham Cole, a consultant cardiologist at Imperial College London, points out that “elevated troponin levels are associated with worse outcomes in COVID-19 patients “.

“Patients with severe COVID-19 disease often have pre-existing health problems related to the heart, such as diabetes, high blood pressure and obesity,” he continues. “However, during a severe COVID-19 infection, the heart also it can be directly affected. Deciphering how the heart can be damaged is difficult, but MRIs of the heart can identify different patterns of injury, which can allow us to make more accurate diagnoses and target treatments more effectively. “

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The team investigated COVID-19 patients discharged through June 2020 from six hospitals in three London NHS trusts. Patients who had abnormal levels of troponin were offered an MRI of the heart after discharge and were compared with those in a control group of patients who had not had COVID-19, as well as 40 healthy volunteers.

“The recovering COVID-19 patients had been very ill – 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 found evidence of high rates of heart muscle injury that could be seen on scans one to two months after discharge,” he adds. “While some of this may have been pre-existing, the MRI scan shows that some were new. and probably caused by COVID-19 “.

The doctor notes that “it is important to note that the pattern of damage to the heart was variable, suggesting that the heart is at risk for different types of injuries. While we detected only a small number of ongoing injuries, we did see injury to the heart. 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% of 148 patients, but there were scarring or injury to the heart muscle in 80 patients (54% ).

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The pattern of tissue healing or injury was caused by inflammation in 39 patients (26%), ischemic heart disease, including infarction or ischemia, in 32 patients (22%), or both in nine patients (6%). Twelve patients (8%) appeared to have ongoing cardiac inflammation.

Professor Fontana notes that “injuries related to inflammation and scarring of the heart are common in COVID-19 patients with elevated troponin discharged from the hospital, but are of limited extent and have little consequence for heart function. “.

The researcher highlights that “these findings provide two opportunities: first, to find ways to prevent injury in the first place, and based on some of the patterns that we have seen, blood clotting may be playing a role. “We have potential treatments. Second,” he continues, “detecting the consequences of an injury during convalescence can identify subjects who would benefit from specific supportive pharmacological treatments to protect cardiac function over time.”

The study findings are limited by the nature of patient selection and included only those who survived a coronavirus infection that required hospital admission. “The convalescent patients in this study had severe illness from COVID-19 and our results say nothing about what happens to people who are not hospitalized with COVID, or those who are hospitalized but without elevated troponin,” he admits.

“The findings indicate potential ways to identify patients at or lower risk and suggest potential strategies that can improve outcomes. More work is needed, and MRI of the heart has shown how useful it is in patient research. with elevation of troponin “, concludes Professor Fontana.

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