COVID-19 study confirms: thorough screening needed during and after hospitalization to better assess cardiovascular disease risks
A thorough screening of hospitalized COVID-19-patients from the acute onset of the disease and on the long term may lead to a better risk estimation of cardiovascular diseases and it may improve the quality of life of these patients through an adapted treatment. This is one of the main messages of the research carried out by UZ Brussel cardiologist Dr. Maria Luiza Luchian, for which she recently obtained her PhD at the Vrije Universiteit Brussel. Although COVID-19 is predominantly a mild flu-like illness, it can have a considerable impact on the cardiovascular system, especially but not only in elderly patients with pre-existing cardiovascular or respiratory diseases and other chronic illnesses.
Dr. Maria Luiza Luchian recently received her PhD from the Vrije Universiteit Brussel. The main subject of her PhD thesis was the impact of COVID-19 pneumonia on the cardiovascular system in patients admitted to hospital. Dr. Luchian followed up 310 patients during the first wave in 2020 from the onset of the acute infection, and at 6 and 12 months after discharge from UZ Brussel, to investigate the effects of COVID-19 on the heart. She evaluated the role of cardiac troponin, a frequent laboratory biomarker assessed during hospitalization and the amount of calcium in the coronary arteries as predictors for potential heart disease and in-hospital mortality in COVID-19 patients. The results show that COVID-19 does have an impact on patients admitted to hospital with COVID-19 pneumonia, therefore a thorough screening at admission and afterwards is crucial for detecting potential heart abnormalities..
The dynamic evolution of cardiac troponin is important in the diagnosis of acute complications of COVID-19
More than one third of hospitalized patients with COVID-19 may develop cardiac injury, reflected in the clinical practice by abnormal levels of cardiac troponin, a protein found predominantly in the heart muscle. Previous studies focused on troponin measurement mainly during hospital admission.
The changes in the evolution of this protein during hospitalization may indicate various acute complications such as myocarditis, myocardial infarction or arrhythmias. However, these complications can occur at any time during the course of COVID-19 not just on admission. Dr. Maria Luiza Luchian's research shows that monitoring the evolution of this parameter is also important. This gives insight on the patients' severity risks and, if necessary, the treatment may be adjusted.
Calcium content in coronary arteries predicts the risk of cardiovascular disease
The amount of calcium is measured using chest CT, which was widely used during COVID-19 pandemic to diagnose the lung infection and possible related complications.
Dr. Maria Luiza Luchian: "The study shows that the absence of calcium in the coronary arteries meant there was a lower cardiovascular risk for COVID-19 patients. A standard chest CT scan, with the assessment of the calcium score using a semi-quantitative method, can be a valuable tool to estimate the risk of heart disease and mortality. It is a simple method with significant advantages in the context of a global health crisis, with less consumption of financial resources, shorter examination time and lower exposure to radiation doses for the patients compared to other techniques known for the evaluation of calcium in the coronary arteries. Importantly, this method can be incorporated into all chest CT scans performed for various clinical questions, not just in COVID-19 patients. The result may change the treatment strategy for the patients."
30% of COVID-19 patients admitted to hospital show cardiac abnormalities one year after the acute illness, even without history of lung or heart disease
143 COVID-19 patients were followed up clinically at 6 months and 12 months after discharge from hospital. This included a clinical examination, measurement of lung function and CT scan of the chest and extensive ultrasound of the heart.
Dr. Maria Luiza Luchian: "In almost a third of the patients, lung abnormalities were observed during chest CT examinations after 6 months, but these were not linked to the ongoing symptoms after the acute episode, referred as 'Long COVID'. However, we observed subtle changes in the heart muscle that could be linked to the persistence of the symptoms, even in patients with no history of lung or heart disease. Further in-depth analysis, using a new technique called Myocardial Work, showed that heart pump function was slightly altered in these patients. This new ultrasound technique takes into account the patient's blood pressure and the deformation of the myocardial fibers, for example their size or shape. In the long term, this could indicate an earlier occurrence of heart diseases."
Photo: Dr. Luchian is performing a Myocardial Work analysis.
Karolien De Prez