Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

J. Ranjit Arnold; Jian L. Yeo; Charley A. Budgeon; Simran Shergill; Rachel England; Hunain Shiwani; Jessica Artico; James C. Moon; Miroslawa Gorecka; Giles Roditi; Andrew Morrow; Kenneth Mangion; Mayooran Shanmuganathan; Christopher A. Miller; Amedeo Chiribiri; Mohammed Alzahir; Sara Ramirez; Andrew Lin; Peter P. Swoboda; Adam K. McDiarmid; Robert Sykes; Trisha Singh; Chiara Bucciarelli-Ducci; Dana Dawson; Marianna Fontana; Charlotte Manisty; Thomas A. Treibel; Eylem Levelt; Robin Young; Alex McConnachie; Stefan Neubauer; Stefan K. Piechnik; Rhodri H. Davies; Vanessa M. Ferreira; Marc R. Dweck; Colin Berry; Gerry P. McCann; John P. Greenwood; Oxford Acute Myocardial Infarction OxAMI Study Investigators; COVID-HEART investigators

doi:10.1007/s10554-024-03304-7

Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

J. Ranjit Arnold^* (Corresponding Author)
, Jian L. Yeo
, Charley A. Budgeon
, Simran Shergill
, Rachel England
, Hunain Shiwani
, Jessica Artico
, James C. Moon
, Miroslawa Gorecka
, Giles Roditi
, Andrew Morrow
, Kenneth Mangion
, Mayooran Shanmuganathan
, Christopher A. Miller
, Amedeo Chiribiri
, Mohammed Alzahir
, Sara Ramirez
, Andrew Lin
, Peter P. Swoboda
, Adam K. McDiarmid

Robert Sykes, Trisha Singh, Chiara Bucciarelli-Ducci, Dana Dawson, Marianna Fontana, Charlotte Manisty, Thomas A. Treibel, Eylem Levelt, Robin Young, Alex McConnachie, Stefan Neubauer, Stefan K. Piechnik, Rhodri H. Davies, Vanessa M. Ferreira, Marc R. Dweck, Colin Berry, Gerry P. McCann, John P. Greenwood, Oxford Acute Myocardial Infarction OxAMI Study Investigators, COVID-HEART investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin +, age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID −/comorbidity +, 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.

Original language	English
Article number	764599
Pages (from-to)	247-256
Number of pages	10
Journal	International Journal of Cardiovascular Imaging
Volume	41
Issue number	2
Early online date	30 Dec 2024
DOIs	https://doi.org/10.1007/s10554-024-03304-7
Publication status	Published - Feb 2025

Bibliographical note

Acknowledgements
Dr Arnold is supported by an NIHR Clinician Scientist Award (CS-2018-18-ST2-007). Dr McCann is funded by an NIHR research professorship (RP-2017-08-ST2-007). Dr Berry acknowledges British Heart Foundation support (Grant RE/18/6134217). Dr Artico received funding from the European Association of Cardiovascular Imaging (EACVI research grant App000073878). Dr Manisty is funded by an NIHR clinician scientist award (CS-2015-15-003). Drs Ferreira, Piechnik, and Neubauer acknowledge the NIHR Oxford Biomedical Research Centre for support of this study. Dr Ferreira acknowledges the British Heart Foundation for support during the study (CH/16/1/32013). Dr Bucciarelli-Ducci is supported in part by the NIHR Biomedical Research Centre at University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol. Additional support was provided by the NIHR Leicester Biomedical Research Centre and the NIHR Leeds Clinical Research Facility. Dr Levelt is funded by a Wellcome Trust (Grant 221690/Z/20/Z). Dr Dweck is supported by the British Heart Foundation (Grant FS/SCRF/21/32010). Dr Greenwood was funded by the NIHR-UKRI COVID-19 Rapid Response Rolling Call (COV0254) and supported by the NIHR Leeds Clinical Research Facility. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors thank the patients and staff who supported this project.

Data Availability Statement

No datasets were generated or analysed during the current study.

Funding

COVID-HEART is funded by the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI) COVID-19 Rapid Response Rolling Call (Grant Number COV0254).

Funders	Funder number
National Institute for Health and Care Research
UK Research and Innovation	COV0254

Keywords

Cardiovascular diseases
Coronavirus
COVID-19
Magnetic resonance imaging
Myocardial ischaemia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Arnold, J. R., Yeo, J. L., Budgeon, C. A., Shergill, S., England, R., Shiwani, H., Artico, J., Moon, J. C., Gorecka, M., Roditi, G., Morrow, A., Mangion, K., Shanmuganathan, M., Miller, C. A., Chiribiri, A., Alzahir, M., Ramirez, S., Lin, A., Swoboda, P. P., ... COVID-HEART investigators (2025). Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study. International Journal of Cardiovascular Imaging, 41(2), 247-256. Article 764599. https://doi.org/10.1007/s10554-024-03304-7

Arnold, JR, Yeo, JL, Budgeon, CA, Shergill, S, England, R, Shiwani, H, Artico, J, Moon, JC, Gorecka, M, Roditi, G, Morrow, A, Mangion, K, Shanmuganathan, M, Miller, CA, Chiribiri, A, Alzahir, M, Ramirez, S, Lin, A, Swoboda, PP, McDiarmid, AK, Sykes, R, Singh, T, Bucciarelli-Ducci, C, Dawson, D, Fontana, M, Manisty, C, Treibel, TA, Levelt, E, Young, R, McConnachie, A, Neubauer, S, Piechnik, SK, Davies, RH, Ferreira, VM, Dweck, MR, Berry, C, McCann, GP, Greenwood, JP, Oxford Acute Myocardial Infarction OxAMI Study Investigators & COVID-HEART investigators 2025, 'Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study', International Journal of Cardiovascular Imaging, vol. 41, no. 2, 764599, pp. 247-256. https://doi.org/10.1007/s10554-024-03304-7

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title = "Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study",

abstract = "The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin +, age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID −/comorbidity +, 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19\%) COVID + /troponin + patients and in 8 (22\%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17\%] vs. 9/47 [19\%] respectively, p = 0.84), or in those with and without scar (7/27 [26\%] vs. 4/32 [13\%] respectively, p = 0.19). Myocardial ischaemia was present in \textasciitilde{} 20\% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.",

keywords = "Cardiovascular diseases, Coronavirus, COVID-19, Magnetic resonance imaging, Myocardial ischaemia",

author = "Arnold, \{J. Ranjit\} and Yeo, \{Jian L.\} and Budgeon, \{Charley A.\} and Simran Shergill and Rachel England and Hunain Shiwani and Jessica Artico and Moon, \{James C.\} and Miroslawa Gorecka and Giles Roditi and Andrew Morrow and Kenneth Mangion and Mayooran Shanmuganathan and Miller, \{Christopher A.\} and Amedeo Chiribiri and Mohammed Alzahir and Sara Ramirez and Andrew Lin and Swoboda, \{Peter P.\} and McDiarmid, \{Adam K.\} and Robert Sykes and Trisha Singh and Chiara Bucciarelli-Ducci and Dana Dawson and Marianna Fontana and Charlotte Manisty and Treibel, \{Thomas A.\} and Eylem Levelt and Robin Young and Alex McConnachie and Stefan Neubauer and Piechnik, \{Stefan K.\} and Davies, \{Rhodri H.\} and Ferreira, \{Vanessa M.\} and Dweck, \{Marc R.\} and Colin Berry and McCann, \{Gerry P.\} and Greenwood, \{John P.\} and \{Oxford Acute Myocardial Infarction OxAMI Study Investigators\} and \{COVID-HEART investigators\}",

note = "Acknowledgements Dr Arnold is supported by an NIHR Clinician Scientist Award (CS-2018-18-ST2-007). Dr McCann is funded by an NIHR research professorship (RP-2017-08-ST2-007). Dr Berry acknowledges British Heart Foundation support (Grant RE/18/6134217). Dr Artico received funding from the European Association of Cardiovascular Imaging (EACVI research grant App000073878). Dr Manisty is funded by an NIHR clinician scientist award (CS-2015-15-003). Drs Ferreira, Piechnik, and Neubauer acknowledge the NIHR Oxford Biomedical Research Centre for support of this study. Dr Ferreira acknowledges the British Heart Foundation for support during the study (CH/16/1/32013). Dr Bucciarelli-Ducci is supported in part by the NIHR Biomedical Research Centre at University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol. Additional support was provided by the NIHR Leicester Biomedical Research Centre and the NIHR Leeds Clinical Research Facility. Dr Levelt is funded by a Wellcome Trust (Grant 221690/Z/20/Z). Dr Dweck is supported by the British Heart Foundation (Grant FS/SCRF/21/32010). Dr Greenwood was funded by the NIHR-UKRI COVID-19 Rapid Response Rolling Call (COV0254) and supported by the NIHR Leeds Clinical Research Facility. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors thank the patients and staff who supported this project.",

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language = "English",

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T1 - Myocardial ischaemia following COVID-19

T2 - a cardiovascular magnetic resonance study

AU - Arnold, J. Ranjit

AU - Yeo, Jian L.

AU - Budgeon, Charley A.

AU - Shergill, Simran

AU - England, Rachel

AU - Shiwani, Hunain

AU - Artico, Jessica

AU - Moon, James C.

AU - Gorecka, Miroslawa

AU - Roditi, Giles

AU - Morrow, Andrew

AU - Mangion, Kenneth

AU - Shanmuganathan, Mayooran

AU - Miller, Christopher A.

AU - Chiribiri, Amedeo

AU - Alzahir, Mohammed

AU - Ramirez, Sara

AU - Lin, Andrew

AU - Swoboda, Peter P.

AU - McDiarmid, Adam K.

AU - Sykes, Robert

AU - Singh, Trisha

AU - Bucciarelli-Ducci, Chiara

AU - Dawson, Dana

AU - Fontana, Marianna

AU - Manisty, Charlotte

AU - Treibel, Thomas A.

AU - Levelt, Eylem

AU - Young, Robin

AU - McConnachie, Alex

AU - Neubauer, Stefan

AU - Piechnik, Stefan K.

AU - Davies, Rhodri H.

AU - Ferreira, Vanessa M.

AU - Dweck, Marc R.

AU - Berry, Colin

AU - McCann, Gerry P.

AU - Greenwood, John P.

AU - Oxford Acute Myocardial Infarction OxAMI Study Investigators

AU - COVID-HEART investigators

N1 - Acknowledgements Dr Arnold is supported by an NIHR Clinician Scientist Award (CS-2018-18-ST2-007). Dr McCann is funded by an NIHR research professorship (RP-2017-08-ST2-007). Dr Berry acknowledges British Heart Foundation support (Grant RE/18/6134217). Dr Artico received funding from the European Association of Cardiovascular Imaging (EACVI research grant App000073878). Dr Manisty is funded by an NIHR clinician scientist award (CS-2015-15-003). Drs Ferreira, Piechnik, and Neubauer acknowledge the NIHR Oxford Biomedical Research Centre for support of this study. Dr Ferreira acknowledges the British Heart Foundation for support during the study (CH/16/1/32013). Dr Bucciarelli-Ducci is supported in part by the NIHR Biomedical Research Centre at University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol. Additional support was provided by the NIHR Leicester Biomedical Research Centre and the NIHR Leeds Clinical Research Facility. Dr Levelt is funded by a Wellcome Trust (Grant 221690/Z/20/Z). Dr Dweck is supported by the British Heart Foundation (Grant FS/SCRF/21/32010). Dr Greenwood was funded by the NIHR-UKRI COVID-19 Rapid Response Rolling Call (COV0254) and supported by the NIHR Leeds Clinical Research Facility. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors thank the patients and staff who supported this project.

PY - 2025/2

Y1 - 2025/2

N2 - The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin +, age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID −/comorbidity +, 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.

AB - The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury. We studied 59 patients hospitalised with COVID-19 and elevated serum troponin (COVID + /troponin +, age 61 ± 11 years) and 37 control subjects without COVID-19 or elevated troponin and similar by age and cardiovascular comorbidities (COVID −/comorbidity +, 64 ± 10 years). Subjects underwent multi-parametric CMR (comprising assessment of ventricular volumes, stress perfusion, T1/T2 mapping and scar). The primary endpoint was the frequency of inducible myocardial ischaemia. Inducible ischaemia was evident in 11 (19%) COVID + /troponin + patients and in 8 (22%) control subjects (p = 0.72). In COVID + /troponin + patients with ischaemia, epicardial coronary disease pattern ischaemia was present in eight patients and microvascular disease pattern, in three patients. There was no significant difference in the frequency of inducible ischaemia in COVID + /troponin + patients with previous myocardial infarction and/or revascularisation compared to those without (2/12 [17%] vs. 9/47 [19%] respectively, p = 0.84), or in those with and without scar (7/27 [26%] vs. 4/32 [13%] respectively, p = 0.19). Myocardial ischaemia was present in ~ 20% of patients recently hospitalised with COVID-19 and with elevated cardiac troponin, but this was not different to matched comorbid controls. This finding coupled with the lack of an association between ischaemia and myocardial scar suggests that coronary artery abnormalities are unlikely to be the predominant mechanism underlying COVID-19 induced myocardial injury.

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KW - Coronavirus

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KW - Magnetic resonance imaging

KW - Myocardial ischaemia

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ER -

Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study

Abstract

Bibliographical note

Data Availability Statement

Funding

Keywords

UN SDGs

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