Myocardial involvement after hospitalization for COVID-19 complicated by troponin elevation: a prospective, multicenter, observational study

Artico, J. et al. (2023) Myocardial involvement after hospitalization for COVID-19 complicated by troponin elevation: a prospective, multicenter, observational study. Circulation, 147(5), pp. 364-374. (doi: 10.1161/CIRCULATIONAHA.122.060632) (PMID:36705028) (PMCID:PMC9889203)

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Background: 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. Methods: 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. Results: 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). Conclusions: 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. Registration: URL:; Unique identifier: 58667920.

Item Type:Articles
Additional Information:Supported by NIHR and UK Research and Innovation (COV0254). West Yorkshire and Humber Clinical Research Network (CV070) funded patient information leaflet translation.
Keywords:COVID-19, myocardial infarction, troponin, magnetic resonance imaging, cardiovascular diseases, coronavirus.
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Macfarlane, Professor Peter and McConnachie, Professor Alex and Young, Dr Robin and Roditi, Dr Giles and Mangion, Dr Kenneth and Morrow, Dr Andrew
Authors: Artico, J., Shiwani, H., Moon, J. C., Gorecka, M., McCann, G. P., Roditi, G., Morrow, A., Mangion, K., Lukaschuk, E., Shanmuganathan, M., Miller, C. A., Chiribiri, A., Prasad, S. K., Adam, R. D., Singh, T., Bucciarelli-Ducci, C., Dawson, D., Knight, D., Fontana, M., Manisty, C., Treibel, T. A., Levelt, E., Arnold, R., Macfarlane, P. W., Young, R., McConnachie, A., Neubauer, S., Piechnik, S. K., Davies, R. H., Ferreira, V. M., Dweck, M. R., Berry, C., and Greenwood, J. P.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Circulation
Publisher:American Heart Association
ISSN (Online):1524-4539
Published Online:27 January 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in Circulation 147(5): 364-374
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
312059COVID-HEART - Sub Study 1 Demographic, multi-morbidity and genetic impact in myocardial involvement and its recovery from COVID-19Colin BerryNational Institute for Health Research (NIHR)COV0254, CD20/133244HW - Robertson Centre