Myocardial injury from COVID-19 rarely progressive, U.K. study finds
Few patients who had myocardial injury during a hospitalization for COVID-19 had a major adverse cardiovascular event within a year, and cardiac imaging at six months after discharge showed slight improvement in left ventricular ejection fraction on average.
Patients with myocardial injury from COVID-19 mostly have good outcomes six months to a year later, a study found.
The prospective, longitudinal cohort study included unvaccinated patients found to have myocardial injury, evidenced by troponin elevation, during hospitalization for COVID-19 at any of 25 U.K. medical centers in June 2020 to March 2021 (median age, 61.3 years; 71.1% male). Patients underwent cardiac MRI within 28 days and at six months postdischarge. They were tracked for 12 months and surveyed about their quality of life at discharge and at six months. Results were published by JACC: Cardiovascular Imaging on Aug. 28.
Of 342 patients with baseline imaging, 338 had 12-month follow-up data available. Of these patients, 1.2% had died; 1.8% had new myocardial infarction, acute coronary syndrome, or coronary revascularization; 0.8% had new myopericarditis; and 3.3% had other cardiovascular events requiring hospitalization. A total of 235 patients had imaging performed at six months, and they showed slightly improved left ventricular ejection fraction (1.8%; P<0.001), stable right ventricular ejection fraction (0.4%; P=0.50), unchanged myocardial scar pattern or volume, and no evidence of continued myocardial inflammation. All 26 pericardial effusions had resolved, as had most cases of pneumonitis. Patients reported improved quality of life overall.
“In general, the findings are reassuring. Even in this nonvaccinated population with severe COVID-19 and evidence of myocardial injury, major long-term cardiac sequelae were uncommon, and health status improved in most patients,” said the study authors. “Additionally, the near-universal resolution of pericardial and pleural effusions, along with lung changes, indicates that the inflammatory effects of COVID-19 are predominantly short-lived and nonprogressive.”
An accompanying editorial agreed that the study provides “optimistic data” but noted some reasons for caution in drawing firm conclusions, including limitations in the length of follow-up and the severity of illness among the patient population. “We are reassured by the medium-term myocardial recovery in some patients and the low incidence of adverse outcomes at 12 months in this prospective cohort. Although they are a minority of patients, we await the long-term follow-up on those who continued to have [left ventricular] abnormalities in the medium term, particularly those with nonischemic injury,” the editorialists wrote.
