Groen R A, de Graaf M A, Stöger J L, van Dijkman P R M, Jukema J W, Schalij M J, Geelhoed J J M, Antoni M L
Leiden University Medical Centre, Department of Cardiology, Albinusdreef 2, 2333ZA Leiden, the Netherlands.
Leiden University Medical Centre, Department of Radiology, Albinusdreef 2, 2333ZA Leiden, the Netherlands.
Am Heart J Plus. 2023 Mar;27:100280. doi: 10.1016/j.ahjo.2023.100280. Epub 2023 Feb 23.
Cardiac manifestations are common in COVID-19, often elevated serum troponin levels or myocardial dysfunction on trans-thoracic echocardiography (TTE) is observed. Both parameters are associated with increased in-hospital mortality. Possibly, subclinical coronary atherosclerosis plays a role, of which severity can be assessed by calculating the coronary artery calcium (CAC) score. This study aims to determine the relation between coronary atherosclerosis and cardiac manifestations in COVID-19 survivors.
This study was conducted at the Leiden University Medical Center. All patients admitted for COVID-19 were included and scheduled for a 6-week follow-up visit with trans-thoracic echocardiography (TTE). CAC was assessed according to an ordinal score on non-gated, non-contrast enhanced computed tomography of the chest. Patients with and without CAC were compared on cardiac injury as reflected by elevated serum troponin levels and impaired cardiac function assessed through TTE.
In total, 146 patients were included. Mean age was 62 years and 62 % of the patients were male. During admission, patients with CAC showed significantly higher levels of troponin (19 ng/L vs 10 ng/L; < 0.01). Overall, mild echocardiographic abnormalities were seen; 12 % showed reduced left ventricular function (left ventricular ejection fraction of <50 %) and 14 % reduced right ventricular function (tricuspid annular planar systolic excursion ≤17 mm). Following multivariable adjustments, there was no significant relation between CAC and myocardial function at 6 weeks.
The present study shows that coronary atherosclerosis is associated with cardiac injury in COVID-19 survivors. However, no significant relation with impaired cardiac function was demonstrated.
心脏表现在新型冠状病毒肺炎（COVID-19）中很常见，常观察到血清肌钙蛋白水平升高或经胸超声心动图（TTE）显示心肌功能障碍。这两个参数均与住院死亡率增加相关。亚临床冠状动脉粥样硬化可能起了作用，其严重程度可通过计算冠状动脉钙化（CAC）评分来评估。本研究旨在确定COVID-19幸存者冠状动脉粥样硬化与心脏表现之间的关系。
本研究在莱顿大学医学中心进行。纳入所有因COVID-19入院的患者，并安排进行为期6周的经胸超声心动图（TTE）随访。根据胸部非门控、非增强计算机断层扫描的序数评分评估CAC。比较有和没有CAC的患者在血清肌钙蛋白水平升高所反映的心脏损伤以及通过TTE评估的心脏功能受损方面的情况。
总共纳入了146例患者。平均年龄为62岁，62%的患者为男性。在住院期间，有CAC的患者肌钙蛋白水平显著更高（19 ng/L对10 ng/L；P<0.01）。总体而言，观察到轻度超声心动图异常；12%的患者左心室功能降低（左心室射血分数<50%），14%的患者右心室功能降低（三尖瓣环平面收缩期位移≤17 mm）。经过多变量调整后，6周时CAC与心肌功能之间无显著关系。
本研究表明，冠状动脉粥样硬化与COVID-19幸存者的心脏损伤相关。然而，未证明与心脏功能受损有显著关系。
