Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study.
Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study.
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DOI：
10.1161/circulationaha.122.060632
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发表时间：
2023-01-31
期刊：
影响因子：
37.8
通讯作者：
Greenwood, John P.
中科院分区：
文献类型：
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作者：
Artico, Jessica;Shiwani, Hunain;Moon, James C.;Gorecka, Miroslawa;McCann, Gerry P.;Roditi, Giles;Morrow, Andrew;Mangion, Kenneth;Lukaschuk, Elena;Shanmuganathan, Mayooran;Miller, Christopher A.;Chiribiri, Amedeo;Prasad, Sanjay K.;Adam, Robert D.;Singh, Trisha;Bucciarelli-Ducci, Chiara;Dawson, Dana;Knight, Daniel;Fontana, Marianna;Manisty, Charlotte;Treibel, Thomas A.;Levelt, Eylem;Arnold, Ranjit;Macfarlane, Peter W.;Young, Robin;McConnachie, Alex;Neubauer, Stefan;Piechnik, Stefan K.;Davies, Rhodri H.;Ferreira, Vanessa M.;Dweck, Marc R.;Berry, Colin;Greenwood, John P.
关键词：
新冠肺炎2019年冠状病毒病住院患者急性心肌损伤预后较差。其相关性和发病机制尚不清楚。我们的目的是评估肌钙蛋白升高的住院患者心肌损伤的存在、性质和程度。英国25家医院的342名新冠肺炎患者在2020年6月至2021年3月期间入选，并在出院后28天内进行了磁共振成像扫描。纳入两个前瞻性对照组，包括合并新冠肺炎但肌钙蛋白水平正常(CoVID+/肌钙蛋白−)的患者和113例与年龄和心血管合并症匹配的无新冠肺炎或肌钙蛋白升高的患者(COVID−/共病+)。12个月后进行回归建模以确定主要不良心血管事件的预测因素。在纳入的519名患者中，356名(69%)为男性，年龄中位数(四分位数范围)为61.0岁(53.8，68.8)。任何心脏异常的频率，被定义为左或右室损伤、疤痕或心包疾病，在病例组(61%，207/342)比对照组(36%[冠状病毒−+/肌钙蛋白−]比31%[冠状病毒病/共病+]；P<；两者均为0.001)高2倍。与对照组相比，更多的患者出现了室壁受损(17.2%比3.1%和7.1%)或疤痕(42%比7%和23%；P<；0.001)。心肌损伤类型不同，与对照组相比，患者更有可能发生心肌梗死(13%对2%和7%；P<；0.001)或微梗死(9%对0%和1%；P<；0.001)，但在非缺血性瘢痕中(13%对5%和14%；P=0.1)。使用路易斯湖磁共振成像标准，病例组近期可能心肌炎的患病率为6.7%(23/342)，对照组为1.7%(2/113)(P=0.045)。在随访期间，4例患者死亡，34例(10.2%)随后发生重大心血管不良事件，与对照组(6.1%；P=0.70)相似。心肌瘢痕，而不是既往新冠肺炎感染或肌钙蛋白，是主要不良心血管事件的独立预测因素(优势比，2.25[95%可信区间，1.12~4.57]；P=0.02)。与当代对照组相比，新冠肺炎合并心肌肌钙蛋白水平升高的患者在恢复期早期有更多的心室损害和心肌瘢痕。然而，心肌炎的比例很低，疤痕的发病机制也是多种多样的，包括一种新描述的微梗塞模式。网址：https://www.isrctn.com；唯一标识：58667920。
Acute myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) has a poor prognosis. Its associations and pathogenesis are unclear. Our aim was to assess the presence, nature, and extent of myocardial damage in hospitalized patients with troponin elevation. Across 25 hospitals in the United Kingdom, 342 patients with COVID-19 and an elevated troponin level (COVID+/troponin+) were enrolled between June 2020 and March 2021 and had a magnetic resonance imaging scan within 28 days of discharge. Two prospective control groups were recruited, comprising 64 patients with COVID-19 and normal troponin levels (COVID+/troponin−) and 113 patients without COVID-19 or elevated troponin level matched by age and cardiovascular comorbidities (COVID−/comorbidity+). Regression modeling was performed to identify predictors of major adverse cardiovascular events at 12 months. Of the 519 included patients, 356 (69%) were men, with a median (interquartile range) age of 61.0 years (53.8, 68.8). The frequency of any heart abnormality, defined as left or right ventricular impairment, scar, or pericardial disease, was 2-fold greater in cases (61% [207/342]) compared with controls (36% [COVID+/troponin−] versus 31% [COVID−/comorbidity+]; P<0.001 for both). More cases than controls had ventricular impairment (17.2% versus 3.1% and 7.1%) or scar (42% versus 7% and 23%; P<0.001 for both). The myocardial injury pattern was different, with cases more likely than controls to have infarction (13% versus 2% and 7%; P<0.01) or microinfarction (9% versus 0% and 1%; P<0.001), but there was no difference in nonischemic scar (13% versus 5% and 14%; P=0.10). Using the Lake Louise magnetic resonance imaging criteria, the prevalence of probable recent myocarditis was 6.7% (23/342) in cases compared with 1.7% (2/113) in controls without COVID-19 (P=0.045). During follow-up, 4 patients died and 34 experienced a subsequent major adverse cardiovascular event (10.2%), which was similar to controls (6.1%; P=0.70). Myocardial scar, but not previous COVID-19 infection or troponin, was an independent predictor of major adverse cardiovascular events (odds ratio, 2.25 [95% CI, 1.12–4.57]; P=0.02). Compared with contemporary controls, patients with COVID-19 and elevated cardiac troponin level have more ventricular impairment and myocardial scar in early convalescence. However, the proportion with myocarditis was low and scar pathogenesis was diverse, including a newly described pattern of microinfarction. URL: https://www.isrctn.com; Unique identifier: 58667920.
DOI：
10.1093/ehjcr/ytaa372
发表时间：
2020-12
期刊：
European heart journal. Case reports
影响因子：
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作者：
Bhandari SS;Yeo J;Kotecha D;McCann GP
通讯作者：
McCann GP
DOI：
10.1016/j.jaccas.2021.05.003
发表时间：
2021-06
期刊：
JACC. Case reports
影响因子：
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作者：
Gorecka M;Thirunavukarasu S;Levelt E;Greenwood JP
通讯作者：
Greenwood JP