Elsevier

JACC: Cardiovascular Imaging

Volume 14, Issue 11, November 2021, Pages 2155-2166
JACC: Cardiovascular Imaging

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

https://doi.org/10.1016/j.jcmg.2021.04.011Get rights and content
Under a Creative Commons license
open access

Abstract

Objectives

The purpose of this study was to detect cardiovascular changes after mild severe acute respiratory syndrome-coronavirus-2 infection.

Background

Concern exists that mild coronavirus disease 2019 may cause myocardial and vascular disease.

Methods

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.

Results

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.

Conclusions

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.

Key Words

cardiovascular magnetic resonance
COVID-19
late gadolinium enhancement
myocardial edema
myocarditis
SARS-CoV-2
troponin

Abbreviations and Acronyms

CMR
cardiovascular magnetic resonance
COVID-19
coronavirus disease-2019
hsTnT
high-sensitivity troponin T
LGE
late gadolinium enhancement
LV
left ventricular
NT-proBNP
N-terminal pro–B-type natriuretic peptide
SARS-CoV-2
severe acute respiratory syndrome-coronavirus-2

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The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs Joy and Artico contributed equally to this work and are joint first authors.

Drs Treibel and Manisty and Prof Moon contributed equally to this work and are joint last authors.