Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)
Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)
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DOI：
10.1001/jamacardio.2020.3557
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发表时间：
2020-11-01
期刊：
影响因子：
24
通讯作者：
Nagel, Eike
中科院分区：
文献类型：
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作者：
Puntmann, Valentina O.;Carerj, M. Ludovica;Nagel, Eike
重要性2019年冠状病毒病(新冠肺炎)继续在全球造成相当大的发病率和死亡率。住院患者的病例报告表明，新冠肺炎显著影响心血管系统，但总体影响尚不清楚。目的：为了评估最近从新冠肺炎病中恢复的非入选患者中心肌损伤的存在。设计、背景和参与这项前瞻性观察队列研究的人，于2020年4月至6月在法兰克福大学医院新冠肺炎注册中心确认了100名最近从新冠肺炎病中康复的患者。并进行心血管磁共振(CMR)检查。与年龄匹配和性别匹配的健康志愿者(n=50)和危险因素匹配的患者(n=57)进行比较。结果100例患者中，男性53例(53%)，平均年龄49(14)岁。从新冠肺炎诊断到脑干反应的中位时间间隔为71天(-92天)。在最近从新冠肺炎康复的100名患者中，67名(67%)在家中康复，33名(33%)需要住院治疗。CMR时高敏肌钙蛋白T(HsTnT)>3pg/m L者71例(71%)，显著升高(>13.9pg/m l)者5例(5%)。与健康对照组和危险因素匹配的对照组相比，新近康复的新冠肺炎患者的左心室射血分数较低，左心室容量较大，自然T1和T2较高。78例(78%)新近康复的新冠肺炎患者CMR表现异常，包括心肌固有T1抬高73例，心肌固有T2抬高60例，心肌Gd晚期强化32例，或心包强化22例。在自然T1标测(中位数[IQR]，1119[1092-1150]ms vs 1141[1121-1175]ms；P=0.008)和hsTnT(4.2[3.0-5.9]pg/dL vs 6.3[3.4-7.9]pg/dL；P=0.002)方面，在家庭康复患者与住院患者之间有微小但显著的差异，但在自然T2标测方面无显著差异。所有这些指标都与从确诊新冠肺炎起的时间无关(本地T1：r=0.07；P=.47；本地T2：r=0.14；P=.15；hsTnT：r=-0.07；P=.50)。高敏感性肌钙蛋白T与自然T1标测(r=0.33；P<；.001)和自然T2标测(r=0.18；P=0.01)显著相关。心内膜心肌活检结果严重的患者显示淋巴细胞性炎症。Native T1和T2是检测新冠肺炎相关心肌病变的最佳鉴别指标。结论在这项对最近从新冠肺炎感染中康复的德国患者的研究中，CMR显示78例(78%)患者心脏受累，60例(60%)患者持续心肌炎，与先前存在的条件、急性疾病的严重程度和整个病程以及距离最初诊断的时间无关。这些发现表明，有必要对新冠肺炎的长期心血管后果进行调查。
IMPORTANCE Coronavirus disease 2019 (COVID-19) continues to cause considerable morbidity and mortality worldwide. Case reports of hospitalized patients suggest that COVID-19 prominently affects the cardiovascular system, but the overall impact remains unknown.OBJECTIVE To evaluate the presence of myocardial injury in unselected patients recently recovered from COVID-19 illness.DESIGN, SETTING, AND PARTICIPANTS In this prospective observational cohort study, 100 patients recently recovered from COVID-19 illness were identified from the University Hospital Frankfurt COVID-19 Registry between April and June 2020.EXPOSURE Recent recovery from severe acute respiratory syndrome coronavirus 2 infection, as determined by reverse transcription-polymerase chain reaction on swab test of the upper respiratory tract.MAIN OUTCOMES AND MEASURES Demographic characteristics, cardiac blood markers, and cardiovascular magnetic resonance (CMR) imaging were obtained. Comparisons were made with age-matched and sex-matched control groups of healthy volunteers (n = 50) and risk factor-matched patients (n = 57).RESULTS Of the 100 included patients, 53 (53%) were male, and the mean (SD) age was 49 (14) years. The median (IQR) time interval between COVID-19 diagnosis and CMR was 71 (64-92) days. Of the 100 patients recently recovered from COVID-19, 67 (67%) recovered at home, while 33 (33%) required hospitalization. At the time of CMR, high-sensitivity troponin T (hsTnT) was detectable (greater than 3 pg/mL) in 71 patients recently recovered from COVID-19 (71%) and significantly elevated (greater than 13.9 pg/mL) in 5 patients (5%). Compared with healthy controls and risk factor-matched controls, patients recently recovered from COVID-19 had lower left ventricular ejection fraction, higher left ventricle volumes, and raised native T1 and T2. A total of 78 patients recently recovered from COVID-19 (78%) had abnormal CMR findings, including raised myocardial native T1 (n = 73), raised myocardial native T2 (n = 60), myocardial late gadolinium enhancement (n = 32), or pericardial enhancement (n = 22). There was a small but significant difference between patients who recovered at home vs in the hospital for native T1 mapping (median [IQR], 1119 [1092-1150] ms vs 1141 [1121-1175] ms; P = .008) and hsTnT (4.2 [3.0-5.9] pg/dL vs 6.3 [3.4-7.9] pg/dL; P = .002) but not for native T2 mapping. None of these measures were correlated with time from COVID-19 diagnosis (native T1: r = 0.07; P = .47; native T2: r = 0.14; P = .15; hsTnT: r = -0.07; P = .50). High-sensitivity troponin T was significantly correlated with native T1 mapping (r = 0.33; P < .001) and native T2 mapping (r = 0.18; P = .01). Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation. Native T1 and T2 were the measures with the best discriminatory ability to detect COVID-19-related myocardial pathology.CONCLUSIONS AND RELEVANCE In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.