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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

基本信息

批准号：
10673997
负责人：
Jiwon Kim
金额：
$ 64.01万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
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

项目摘要

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.

项目摘要/摘要冠状病毒病2019年(新冠肺炎)是一种持续的全球大流行。尽管短期内死亡率很高风险方面，绝大多数感染患者在急性疾病中幸存下来，导致越来越多的人面临风险对于长期的活动。调查数据显示，新冠肺炎后，心肺症状较为常见报告在急性感染60天后疲倦(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显示的心肌组织异常在新冠肺炎中很常见幸存者-增加了症状源于病毒对心脏影响的可能性。然而，CMR的调查结果是数据受到规模较小和临床数据易受推荐偏向影响的限制，增加了以下方面的不确定性概括性。心肌组织特性改变(纤维化、水肿)是否影响临床也是未知的。结果。我们研究的中心假设是CMR组织定征将逐渐应用于临床评估和心脏收缩功能预测长期心肺症状、努力新冠肺炎存活者的耐受性和预后。为了测试这一点，我们将研究来自活跃的多个纽约市新冠肺炎幸存者登记：我们已经利用了来自以下方面的超声心动图成像数据这项研究表明：(1)不利的心脏重构(扩张、功能障碍)在短期内显著增加。死亡率，(2)新冠肺炎显著改变左、右室重构，(3)许多患者存活最初住院的新冠肺炎患者有不良的心脏重构--包括40%的左心室功能障碍和32%的患者有不良的右室重构(扩张、功能障碍)：我们目前的提案将延长在我们的初步数据上逻辑地测试CMR组织特征是否提供增量预测在逆转重塑和预后方面有实用价值。至少510名新冠肺炎幸存者将接受研究。回波将在新冠肺炎期间和之后分析纵向重塑，以及在预先指定的时间(6- 12、36个月)随访时间点。将采用成熟的和新的CMR技术，包括评估心脏和肺损伤，高分辨率(3D)心肌组织特征，以及心肺血氧合。同时，生活质量、努力耐力(6分钟步行试验)、生物标记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。目标1 将确定新冠肺炎幸存者生活质量受损和努力不耐受的决定因素。目标2将检测CMR的心肌组织损伤是否与收缩功能受损有关，以及纤维化是否预示着收缩复苏。目标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、死亡率)。结果将解决关键问题关于新冠肺炎对心脏影响的知识差距是指导监测、风险分层和为数以百万计的新冠肺炎幸存者提供靶向治疗，这些幸存者面临心肌损伤、心肺症状、预后不良。