Almost half of COVID-19 patients who have been hospitalised show scan abnormalities that resemble the early stages of heart failure, a global research study led by researchers at Edinburgh University reveals. One in seven hospitalised patients show severe heart damage that could have a major effect on their health, the international study shows.
The findings highlight the impact of COVID-19 on the heart and suggest that monitoring heart function with scans is an important part of care for people with severe COVID-19.
Researchers from the British Heart Foundation Centre of Research Excellence at the University examined heart scans, known as echocardiograms, from 1216 COVID-19 patients across 69 countries.
Among patients who did not have pre-existing heart disease, almost half had abnormal changes to how the heart was pumping; and one in eight patients with no pre-existing heart disease showed evidence of severe heart dysfunction.
Researchers say these changes had not been detected in these patients before and could be a direct effect of the virus.
Damage was seen in both sides of the heart. Damage to the right side of the heart is known to occur in cases of severe flu, but damage to the left side was observed more commonly with COVID-19 than has been reported with flu say researchers. A third of patients changed their treatment to help support their heart as a result of the echocardiogram.
The researchers caution that only those who had suspected heart problems received a heart scan, meaning it is not known how common heart changes are in those who did not receive a scan.
“COVID-19 is a complex, multisystem disease that can have profound effects on many parts of the body, including the heart. Many doctors have been reluctant to order echocardiograms for patients with COVID-19 because it’s an added procedure which involves close contact with patients.
“Our work shows that these scans are important – they changed the treatment for a third of patients who received them. We now need to understand whether this heart damage is reversible and what the long-term consequences of COVID-19 infection are on the heart,” said Professor Marc Dweck at the University of Edinburgh
Follow up studies using MRI scan are now underway across the UK to understand whether the changes to heart function will be long-lasting in people who have recovered from COVID-19.
The study was funded by the British Heart Foundation.
Abstract
Aims: To describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography.
Methods and results: In a prospective international survey, we captured echocardiography findings in patients with presumed or confirmed COVID-19 between 3 and 20 April 2020. Patient characteristics, indications, findings, and impact of echocardiography on management were recorded. Multivariable logistic regression identified predictors of echocardiographic abnormalities. A total of 1216 patients [62 (52–71) years, 70% male] from 69 countries across six continents were included. Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Severe cardiac disease (severe ventricular dysfunction or tamponade) was observed in 182 (15%) patients. In those without pre-existing cardiac disease (n = 901), the echocardiogram was abnormal in 46%, and 13% had severe disease. Independent predictors of left and right ventricular abnormalities were distinct, including elevated natriuretic peptides [adjusted odds ratio (OR) 2.96, 95% confidence interval (CI) 1.75–5.05) and cardiac troponin (OR 1.69, 95% CI 1.13–2.53) for the former, and severity of COVID-19 symptoms (OR 3.19, 95% CI 1.73–6.10) for the latter. Echocardiography changed management in 33% of patients.
Conclusion: In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.
Authors
Marc R Dweck, Anda Bularga, Rebecca T Hahn, Rong Bing, Kuan Ken Lee, Andrew R Chapman, Audrey White, Giovanni Di Salvo, Leyla Elif Sade, Keith Pearce, David E Newby, Bogdan A Popescu, Erwan Donal, Bernard Cosyns, Thor Edvardsen, Nicholas L Mills, Kristina Haugaa
The findings build on a growing body of evidence that COVID-19 affects not only the lungs but other organs including the brain and heart. The Guardian reports that early studies from China and Italy showed that up to 20% of patients in hospital with COVID-19 had heart damage.
Because the virus causes inflammation and fluid build-up in the lungs, the heart often has to work harder to pump oxygen-carrying blood around the body. The heart can fail from working too hard, or the lack of oxygen can cause tissue damage to the heart. In other patients, the virus can infect the heart muscle directly and make it inflamed.
[link url="https://www.ed.ac.uk/covid-19-response/latest-news/coronavirus-affects-heart"]Edinburgh University material[/link]
[link url="https://academic.oup.com/ehjcimaging/article/doi/10.1093/ehjci/jeaa178/5859292"]European Heart Journal Cardiovascular Imaging abstract[/link]
[link url="https://www.theguardian.com/science/2020/jul/13/heart-scans-of-covid-19-patients-show-range-of-abnormalities"]Full report in The Guardian[/link]