Demographic, multi-morbidity and genetic impact on myocardial involvement and its recovery from COVID-19: the COVID-HEART study

Up to 1 in 5 patients hospitalised by COVID-19 have evidence of heart muscle injury as measured from a blood test. This is associated with a high death rate. Using an MRI scan of the heart we aim to investigate how often, and in what way, the heart becomes damaged, and how the heart recovers 6 months later. We need to know how heart muscle damage and recovery is affected by age, sex, ethnicity and other medical conditions (such as diabetes, high blood pressure, heart disease and narrowing of blood vessels), as these are also known to be associated with high death rates. We also want to see if we can improve the diagnosis of viral heart damage from a simple ECG, which may save patients having invasive heart tests which can be uncomfortable, are expensive and carry a small risk of serious complications and may put healthcare staff at increased risk of exposure to COVID-19.

COVID-HEART is a large UK multi-centre consortium committed to work together to answer a set of unique and important clinical questions. The bid is backed by the major UK professional cardiovascular societies and the NIHR-BHF Cardiovascular Partnership have designated it as a “COVID-19 Cardiovascular Disease UK Flagship Project” (see attached letter). Whilst up to 20% of hospitalised COVID-19 patients may have cardiac injury based on serum troponin (and associated with high mortality), this is non-specific and can relate to pericarditis, myocarditis, acute coronary syndromes, acute heart failure, arrhythmias, or simply hypoxia/sepsis/shock. Cardiovascular magnetic resonance (CMR) can make a specific diagnosis and is recommended in European Society of Cardiology practice guidelines. We will use CMR to determine 1) the UK prevalence of acute myocardial injury/myocarditis secondary to COVID-19 and the severity of presentation; 2) how clinical outcomes associate with recognised risk factors for mortality such as age, sex, ethnicity and comorbidities (diabetes, hypertension, heart failure, and coronary/peripheral vascular disease; 3) if there are differences in myocardial recovery at 6 months dependent on demographics, genetics and comorbidities, and how this impacts on patient quality of life and functional capacity; 4) if we can improve the ECG diagnosis of myocarditis minimising the requirement for invasive cardiac investigations. Ethics approval has been granted for clinical CMR scans enabling us to start quickly, and if funded we would extend this approval to include the additional research scans, other investigations, patient reported outcome measures.