Cardiac Magnetic Resonance for Tissue Characterization Based Risk Stratification of Cardiopulmonary Symptoms, Effort Tolerance, and Prognosis Among COVID-19 Survivors

心脏磁共振对 COVID-19 幸存者心肺症状、努力耐受力和预后的基于组织特征的风险分层

• 批准号: 10280610
• 负责人: Jiwon Kim
• 金额: $ 70.08万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10280610
• 关键词: 3-Dimensional; Acute; Address; Affect; Arrhythmia; Biological Markers; Blood; COVID-19; COVID-19 patient; Cardiac; Cardiopulmonary; Chest Pain; Clinical; Clinical Data; Clinical assessments; Data; Data Reporting; Dyspnea; Echocardiography; Edema; Event; Fatigue; Fibrosis; Functional disorder; General Population; Heart; Heart Injuries; Heart Research; Heart failure; Histopathology; Hospitalization; Image; Impairment; Infection; Inflammation; Knowledge; Left; Left Ventricular Dysfunction; Longterm Follow-up; Lung; Lung diseases; Magnetic Resonance; Magnetic Resonance Imaging; Measures; Methods; Myocardial dysfunction; Myocardial tissue; Myocardium; New York City; Outcome; Patients; Physiological; Population; Populations at Risk; Prognosis; Property; Pulmonary Pathology; Quality of life; Recovery; Registries; Reporting; Research; Resolution; Right Ventricular Dysfunction; Risk; Specific qualifier value; Structure; Surveys; Survivors; Symptoms; Technology; Testing; Thrombosis; Time; Tissues; Treatment Failure; Uncertainty; United States; Ventricular; Ventricular Remodeling; Viral; Walking; acute infection; adverse outcome; base; clinical biomarkers; clinical predictors; clinically relevant; common symptom; coronary fibrosis; data registry; follow-up; functional status; improved; indexing; lung injury; mortality; mortality risk; multi-ethnic; myocardial injury; novel; pandemic disease; predict clinical outcome; response; risk stratification; stem; study population; targeted treatment; therapy development; tissue injury

PROJECT SUMMARY / ABSTRACT Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic. Despite substantial short term mortality risk, the overwhelming majority of infected patients survive acute illness, resulting in a growing population at risk for long term events. Cardiopulmonary symptoms are common after COVID-19, as shown by survey data reporting fatigue (53%), dyspnea (43%), and worsened quality of life (44%) 60 days after acute infection, but mechanism and time course of symptoms are unknown. Recent studies and our own preliminary data have shown myocardial tissue abnormalities on cardiac magnetic resonance (CMR) to be common in COVID-19 survivors – raising the possibility that symptoms stem from viral effects on the heart. However, CMR findings to date are limited by small size and clinical data susceptible to referral bias, raising uncertainty as to generalizability. It is also unknown whether altered myocardial tissue properties (fibrosis, edema) impact clinical outcomes. The central hypothesis of our research is that CMR tissue characterization will be incremental to clinical assessment and cardiac contractile function for prediction of long-term cardiopulmonary symptoms, effort tolerance, and prognosis among COVID-19 survivors. To test this, we will study patients from an active multi- ethnic NYC registry of COVID-19 survivors: We have already leveraged echocardiographic imaging data from this registry to show that (1) adverse cardiac remodeling (dilation, dysfunction) markedly augments short term mortality, (2) COVID-19 acutely alters left and right ventricular remodeling, and (3) many patients who survive initial hospitalization for COVID-19 have adverse cardiac remodeling – including 40% with left ventricular (LV) dysfunction and 32% with adverse RV remodeling (dilation, dysfunction): Our current proposal will extend logically on our preliminary data to test whether CMR tissue characterization provides incremental predictive utility with respect to reverse remodeling and prognosis. At least 510 COVID-19 survivors will be studied. Echo will be analyzed at time of and following COVID-19 for longitudinal remodeling, as will CMR at pre-specified (6- 12, 36 month) follow-up timepoints. Established and novel CMR technologies will be employed, including assessment of cardiac and lung injury, high resolution (3D) myocardial tissue characterization, and cardiopulmonary blood oxygenation. In parallel, QOL, effort tolerance (6-minute walk test), biomarkers, and rigorous follow-up will be obtained to discern clinical implications and relative utility of imaging findings. Aim 1 will identify determinants of impaired quality of life and effort intolerance among COVID-19 survivors. Aim 2 will test whether myocardial tissue injury on CMR is associated with impaired contractility, and whether fibrosis predicts contractile recovery. Aim 3 will determine whether myocardial tissue injury is independently associated with adverse prognosis (new onset clinical heart failure, hospitalization, mortality). Results will address key knowledge gaps regarding COVID-19 effects on the heart necessary to guide surveillance, risk stratification, and targeted therapies for millions of COVID-19 survivors at risk for myocardial injury, cardiopulmonary symptoms, and adverse prognosis.

项目总结/摘要 2019冠状病毒病（COVID-19）是一种持续的全球大流行病。尽管短期内死亡率很高 风险，绝大多数感染患者在急性疾病中存活，导致风险人口不断增加 对于长期事件。调查数据显示，COVID-19后心脏病症状很常见 急性感染后60天报告疲劳（53%）、呼吸困难（43%）和生活质量恶化（44%），但 症状的机制和时间进程尚不清楚。最近的研究和我们自己的初步数据表明， 心脏磁共振（CMR）显示心肌组织异常在COVID-19中很常见 幸存者-提高了症状源于病毒对心脏影响的可能性。然而，CMR调查结果显示， 数据受到样本量小和临床数据易受转诊偏倚的限制，增加了以下方面的不确定性： 普遍性还不清楚心肌组织特性改变（纤维化、水肿）是否影响临床 结果。 我们研究的中心假设是CMR组织表征将增加到临床 评估和心脏收缩功能，用于预测长期心肺症状、努力 耐受性和预后。为了验证这一点，我们将研究一个活跃的多- COVID-19幸存者的纽约种族登记：我们已经利用了来自 该登记研究显示：（1）不良心脏重塑（扩张、功能障碍）显著增加了短期 死亡率，（2）COVID-19急性改变了左心室和右心室重塑，（3）许多存活的患者 因COVID-19首次住院治疗有不良心脏重塑-包括40%的左心室（LV） 功能障碍和32%的不良RV重塑（扩张，功能障碍）：我们目前的建议将扩大 逻辑上，我们的初步数据，以测试CMR组织表征是否提供增量预测 在逆转重塑和预后方面的效用。将对至少510名COVID-19幸存者进行研究。回波 将在COVID-19发生时和之后分析纵向重塑，预定义的CMR（6- 12、36个月）随访时间点。将采用成熟和新颖的CMR技术，包括 评估心脏和肺损伤，高分辨率（3D）心肌组织定征，以及 心肺血液氧合同时，QOL、努力耐力（6分钟步行试验）、生物标志物和 将获得严格的随访以辨别临床意义和成像结果的相对效用。要求1 将确定COVID-19幸存者生活质量受损和努力不耐受的决定因素。目标2将 测试CMR上的心肌组织损伤是否与收缩力受损相关，以及纤维化是否与心肌纤维化相关。 预测收缩性恢复。目的3将确定心肌组织损伤是否独立相关 预后不良（新发临床心力衰竭、住院、死亡）。结果将解决关键问题 关于COVID-19对心脏影响的知识缺口，这是指导监测、风险分层和 为数百万有心肌损伤、心肺症状风险的COVID-19幸存者提供靶向治疗， 和不良预后。