Scientists have identified the different types of structural injuries to the heart experienced by COVID-19 patients that are associated with life-threatening blood clots and cardiac arrest, findings that may lead to better monitoring of people vulnerable to these deadly conditions.
According to the study, published in the Journal of the American College of Cardiology, these abnormalities in the heart are associated with higher risk of death among hospitalised COVID-19 patients.
The researchers believe the new insights may help doctors better understand the mechanism of cardiac injury among those infected with the novel coronavirus, leading to quicker identification of patients at risk and guidance on future therapies.
“Early detection of structural abnormalities may dictate more appropriate treatments, including anticoagulation and other approaches for hospitalised and post-hospitalised patients,” said study co-author Valentin Fuster from The Mount Sinai Hospital.
In the current study, the scientists looked at the levels of the protein troponin, which is released when the heart muscle becomes damaged, in combination with the presence of cardiac scan abnormalities seen using an echocardiogram instrument. The researchers found that the combination was associated with worse prognosis and mortality than troponin elevations alone.
Diverse cardiac structural abnormalities
“This is one of the first studies to provide detailed echocardiographic and electrocardiographic data in hospitalized patients with COVID-19 and laboratory evidence of myocardial injury,” explained study corresponding author Gennaro Giustino from The Mount Sinai Hospital. “We found that among COVID-19 patients who underwent transthoracic echocardiography, these cardiac structural abnormalities were diverse and present in nearly two-thirds of patients.”
The scientists assessed the heart scans of 305 adult patients with confirmed positive COVID-19 admitted to four New York City hospitals within the Mount Sinai Health System, and two hospitals in Milan, Italy, between March and May 2020.
According to the study, the average age of the patients was 63 years and 67.2% were men.
It noted that 190 of the 305 patients had evidence of heart damage — 118 of them had heart damage at the time of hospital admission, and 72 developed cardiac injury during hospitalisation.
According to the study,
- 26.3% of the patients had dysfunction in the heart’s right ventricle chamber
- 23.7% had regional left ventricular wall motion abnormalities
- 18.4% had cardiac abnormalities which can be associated with inflammation of the heart and heart damage
- 13.2% had grade II or III diastolic dysfunction — a condition leading to stiffer cardiac chambers.
- 7.2% had extra fluid around the heart that causes abnormal pumping of the heart
The researchers said they adjusted for other major complications from COVID-19 including shock, acute respiratory distress syndrome, and renal failure.
According to the scientists, troponin elevation was 5.2% among patients who did not have heart injury, compared to 18.6% for patients with myocardial injury but without heart scan abnormalities, and 31.7% for those with heart injury that could be spotted visibly using the echocardiogram.
“Our study shows that an echocardiogram performed with appropriate personal protection considerations is a useful and important tool in early identification of patients at greater risk for COVID-19-related cardiac injury, who may benefit from a more aggressive therapeutic approach earlier in their hospitalisation,” said study co-author Martin Goldman from the Icahn School of Medicine at Mount Sinai in the U.S. “Additionally, because this is a new disease with lingering symptoms, we plan on following these patients closely using imaging to evaluate the evolution and hopefully resolution of these cardiac issues.”