Advanced Cardiac Imaging Findings in Patients Recently Recovered from COVID-19 Stephanie 1Donald
1 Busch ,
Beom Soo
2 Kim ,
John N.
and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital
Background
2Department
Results a)
b)
Figure 1: A 59-year-old man with prior COVID-19 infection and new onset atrial fibrillation was referred for cardiac evaluation. a) SPECT imaging (short axis, apex to base) revealed large, predominantly fixed perfusion defects (arrows) that did not resolve with prone image position/attenuation correction. b) Coronary angiography revealed no obstructive disease in the coronary arteries.
Hypothesis
a)
b)
We believe that further evaluation of patients who have recovered from COVID-19 will support anecdotal and case report evidence of an increased prevalence of myocardial injury in patients who have recovered from COVID-19 compared to age-matched patients who have not contracted COVID-19.
Methods Patient Selection: • Patients presenting with symptoms of cardiac injury were screened for prior COVID-19 infection through the Northwell EMR • Only patients who had recovered from COVID-19 by a negative PCR test or full resolution of symptoms including fever, cough, shortness of breath were included in the study • Patients with a documented history of abnormal TTE, abnormal SPECT, coronary artery disease, positive troponin, and/or myocarditis were excluded from the study Analysis Methods: • Patients presenting with symptoms of cardiac injury were evaluated using TTE and SPECT imaging modalities • TTE and SPECT images of patients with prior COVID-19 infection were evaluated for summed strain score, summed rest score, and summed difference scores and compared to age-matched controls with no prior COVID-19 infection, with data points entered into RedCap • Data points will be compared between patient populations by student’s T test to determine presence of sub-clinical myocardial strain following COVID-19 infection
of Cardiology,
Future Directions Patient Enrollment: • Patients who meet the study criteria of presenting symptoms of cardiac injury with a history of recovered COVID-19 infection and no prior diagnosis of coronary artery disease, positive troponin, or myocarditis will continue to be identified and retrospectively enrolled from the Northwell EMR database • Patients will be selected on an ongoing basis with the intent to evaluate potential cardiac effects in the absence of an acute myocardial syndrome • Demographic data of enrolled patients will be collected from the Northwell EMR to provide information for a comparable age/sex-matched control patient population • Age/sex-matched patients who underwent diagnostic TTE and SPECT imaging studies with no prior history of COVID-19 infection will be retrospectively enrolled as a control population for myocardial perfusion data
The COVID-19 pandemic has caused significant worldwide morbidity and mortality, with many patients experiencing long-lasting effects of infection even months after recovery. While COVID-19 is primarily a respiratory virus, many patients have experienced cardiovascular effects both in the acute phase of COVID-19 infection and in the post-infection phase after recovering from the virus.1 These cardiac effects are of interest due to their potential impact on patient mortality even in those without a previous history of obstructive coronary artery disease. While the mechanism of these cardiac effects is not entirely understood, the presumed pathophysiologic mechanisms of cardiac injury due to COVID-19 infection include inflammatory plaque rupture, increased myocardial stress due to a high output state, and possibly infection-mediated systemic endothelitis via angiotensinconverting enzyme 2 receptors.2 This study aims to address these post-infection cardiac abnormalities by analyzing myocardial perfusion and stress factors using both transthoracic echocardiography (TTE) and single-photon emission computed tomography (SPECT) imaging modalities.
1,2 Makaryus
Figure 2: A 51-year-old woman with a PMH of hyperthyroidism and recent COVID-19 infection presented with chest pain, dyspnea on exertion and palpitations that began 4 weeks following her COVID-19 infection. a) TTE analysis demonstrated normal left and right ventricular systolic function and normal diastolic function. b) TTE strain analysis revealed reduced function in a non-coronary distribution.
Conclusions • Case reports currently indicate that even mild COVID-19 infection is associated with potential myocardial injury even in the absence of obstructive artery disease Figure 7: Independent CRISPR knockout of CDK4 or CDK6 from thecellviral does not following cause dropoutrecovery in most breast cancer lines infection. studied.
• These reports indicate a further need to elucidate the cause of unexplained perfusion abnormalities in patients who have recovered from COVID-19 infection compared to patients who have not been infected with COVID-19 in order to determine the potential cardiac sequelae associated with COVID-19.
Data Collection: • TTE and SPECT imaging studies will be collected from patient chart information following workup for potential cardiac injury • TTE images, SPECT images, and stress echocardiography studies will be collected and analyzed for summed strain score, summed rest score, and summed difference scores as evidence of myocardial perfusion and strain abnormalities Data Analysis: • SPECT nuclear scan images will be assessed by two independent readers for summed strain score, summed rest score, and summed difference scores • TTE data will be analyzed for ventricular systolic and diastolic function, and TTE strain data will be assessed for patterns of myocardial dysfunction representative of coronary or non-coronary distribution patterns • Imaging data and strain scores from patients with a history of COVID-19 will be compared to those with no history of COVID-19 infection to determine the incidence and etiology of unexplained cardiac perfusion abnormalities following COVID-19 infection, using student t tests, chi-square tests, and Shapiro-Wilk tests to determine significance between variables
Resources References: 1Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID19. JAMA. 2020;324(6):603–605. 2Puntmann et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Jul 27:e203557. Acknowledgements: Student funding provided by the ZSOM Office of Student Research summer stipend