当前位置: X-MOL 学术Circulation › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study.
Circulation ( IF 37.8 ) Pub Date : 2023-01-27 , DOI: 10.1161/circulationaha.122.060632
Jessica Artico 1 , Hunain Shiwani 1 , James C Moon 1 , Miroslawa Gorecka 2 , Gerry P McCann 3 , Giles Roditi 4 , Andrew Morrow 4 , Kenneth Mangion 4 , Elena Lukaschuk 5 , Mayooran Shanmuganathan 5 , Christopher A Miller 6 , Amedeo Chiribiri 7 , Sanjay K Prasad 8 , Robert D Adam 1 , Trisha Singh 9 , Chiara Bucciarelli-Ducci 4, 7, 10, 11 , Dana Dawson 12 , Daniel Knight 13 , Marianna Fontana 13 , Charlotte Manisty 1 , Thomas A Treibel 1 , Eylem Levelt 2 , Ranjit Arnold 3 , Peter W Macfarlane 14 , Robin Young 15 , Alex McConnachie 15 , Stefan Neubauer 5 , Stefan K Piechnik 5 , Rhodri H Davies 1 , Vanessa M Ferreira 5 , Marc R Dweck 9 , Colin Berry 4 , , John P Greenwood 2
Affiliation  

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: https://www.isrctn.com; Unique identifier: 58667920.

中文翻译:

因 COVID-19 住院后并发肌钙蛋白升高的心肌受累:一项前瞻性、多中心、观察性研究。

背景 2019 年冠状病毒病(COVID-19)住院患者的急性心肌损伤预后较差。其关联和发病机制尚不清楚。我们的目的是评估肌钙蛋白升高的住院患者心肌损伤的存在、性质和程度。方法 2020 年 6 月至 2021 年 3 月期间,英国 25 家医院招募了 342 名患有 COVID-19 且肌钙蛋白水平升高(COVID+/肌钙蛋白+)的患者,并在出院后 28 天内接受了磁共振成像扫描。招募了两个前瞻性对照组,其中包括 64 名患有 COVID-19 且肌钙蛋白水平正常 (COVID+/肌钙蛋白-) 的患者和 113 名未患有 COVID-19 或肌钙蛋白水平升高且年龄和心血管合并症 (COVID-/合并症+) 的患者。进行回归模型以确定 12 个月时主要不良心血管事件的预测因素。结果 在纳入的 519 名患者中,356 名 (69%) 为男性,中位年龄(四分位数范围)为 61.0 岁(53.8,68.8)。任何心脏异常(定义为左心室或右心室受损、疤痕或心包疾病)的发生频率在病例组中 (61% [207/342]) 是对照组的 2 倍(36% [COVID+/肌钙蛋白-] 对31% [COVID-/合并症+];两者 P<0.001)。与对照组相比,更多病例有心室损伤(17.2% vs 3.1% 和 7.1%)或疤痕(42% vs 7% 和 23%;两者 P<0.001)。心肌损伤模式不同,病例比对照组更容易发生梗塞(13% vs 2%和7%;P<0.01)或微梗塞(9% vs 0%和1%;P<0.001),但非缺血性疤痕没有差异(13% 对比 5% 和 14%;P=0.10)。使用路易斯湖磁共振成像标准,病例中可能近期发生心肌炎的患病率为 6.7% (23/342),而未患 COVID-19 的对照组为 1.7% (2/113) (P=0.045)。随访期间,4 名患者死亡,34 名患者随后发生重大心血管不良事件(10.2%),与对照组相似(6.1%;P=0.70)。心肌疤痕,而非既往的 COVID-19 感染或肌钙蛋白,是主要不良心血管事件的独立预测因子(比值比,2.25 [95% CI,1.12-4.57];P=0.02)。结论 与同时代对照者相比,心肌肌钙蛋白水平升高的 COVID-19 患者在康复早期有更多的心室损害和心肌疤痕。然而,心肌炎的比例较低,疤痕发病机制多样,包括新描述的微梗塞模式。注册网址:https://www.isrctn.com;唯一标识符:58667920。
更新日期:2023-01-27
down
wechat
bug