Prospective Case-Control Study of Cardiovascular Abnormalities 6 Months Following Mild COVID-19 in Healthcare Workers

• Published in: JACC. Cardiovascular imaging Vol. 14; no. 11; pp. 2155 - 2166
• Main Authors: Joy, George, Artico, Jessica, Kurdi, Hibba, Seraphim, Andreas, Lau, Clement, Thornton, George D., Oliveira, Marta Fontes, Adam, Robert Daniel, Aziminia, Nikoo, Menacho, Katia, Chacko, Liza, Brown, James T., Patel, Rishi K., Shiwani, Hunain, Bhuva, Anish, Augusto, Joao B., Andiapen, Mervyn, McKnight, Aine, Noursadeghi, Mahdad, Pierce, Iain, Evain, Timothée, Captur, Gabriella, Davies, Rhodri H., Greenwood, John P., Fontana, Marianna, Kellman, Peter, Schelbert, Erik B., Treibel, Thomas A., Manisty, Charlotte, Moon, James C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation
• Subjects: Adolescent; Adult; Artificial Intelligence; Cardiovascular Abnormalities; cardiovascular magnetic resonance; Case-Control Studies; Contrast Media; COVID-19; Female; Gadolinium; Health Personnel; Humans; late gadolinium enhancement; Magnetic Resonance Imaging, Cine; Male; Middle Aged; myocardial edema; myocarditis; Myocardium; Original Research; Predictive Value of Tests; Prospective Studies; SARS-CoV-2; troponin; Ventricular Function, Left; Young Adult; COVID-19; myocardial edema; hsTnT; SARS-CoV-2; NT-proBNP; troponin; myocarditis; CMR; LV; late gadolinium enhancement; LGE; cardiovascular magnetic resonance
• ISSN: 1936-878X; 1876-7591; 1876-7591
• DOI: 10.1016/j.jcmg.2021.04.011

The purpose of this study was to detect cardiovascular changes after mild severe acute respiratory syndrome-coronavirus-2 infection. Concern exists that mild coronavirus disease 2019 may cause myocardial and vascular disease. Participants were recruited from COVIDsortium, a 3-hospital prospective study of 731 health care workers who underwent first-wave weekly symptom, polymerase chain reaction, and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post-infection, 74 seropositive and 75 age-, sex-, and ethnicity-matched seronegative control subjects were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated cardiovascular magnetic resonance and blood biomarkers). Analysis was blinded, using objective artificial intelligence analytics where available. A total of 149 subjects (mean age 37 years, range 18 to 63 years, 58% women) were recruited. Seropositive infections had been mild with case definition, noncase definition, and asymptomatic disease in 45 (61%), 18 (24%), and 11 (15%), respectively, with 1 person hospitalized (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass, atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T1, T2, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro–B-type natriuretic peptide). With abnormal defined by the 75 seronegatives (2 SDs from mean, e.g., ejection fraction <54%, septal T1 >1,072 ms, septal T2 >52.4 ms), individuals had abnormalities including reduced ejection fraction (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), late gadolinium enhancement (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all N-terminal pro–B-type natriuretic peptide normal). These were distributed equally between seropositive and seronegative individuals. Cardiovascular abnormalities are no more common in seropositive versus seronegative otherwise healthy, workforce representative individuals 6 months post–mild severe acute respiratory syndrome-coronavirus-2 infection. [Display omitted]