Laboratory and Imaging Evaluation of Cardiac Involvement in Patients with Post-Acute COVID-19

Abstract

Background

In the post-acute COVID-19 syndrome, many patients suffer from palpitations, effort-associated fatigue, and even sudden death. The mechanism of heart involvement in this syndrome is uncertain. The main purpose of the study was to identify possible cardiac involvement causes in patients with post-acute COVID-19 by using biomarkers such as NT-proBNP and nitric oxide (NO) and cardiac imaging modalities.

Methods

In this cross-sectional study, a total of 105 participants were included according to the existence of symptoms, and 40 of these participants were asymptomatic patients. The ages of the participants ranged from 20 to 50 years. All patients were healthy before COVID-19. The symptoms were defined as palpitations and/or fatigue association with exercise in post-acute COVID-19 term. The comparison of the two groups was made by using biochemical parameters (NT-proBNP, Troponin I, NO) and imaging techniques (echocardiography, cardiovascular magnetic resonance (CMR) and cardiac positron emission tomography (PET)).

Results

The symptomatic patients had higher NT-proBNP levels compared with asymptomatic patients (132.30±35.15; 76.86±16.79, respectively; p < 0.001). Interestingly, the symptomatic patients had lower NO levels than asymptomatic patients (9.20±3.08; 16.15±6.02, respectively; p < 0.001). Echocardiography and CMR were normal. However, we found regional increased 18F-FDG uptake on cardiac PET to be compatible with myocardial fatigue.

Conclusion

We found elevated NT-proNBP levels, low serum NO levels, and increased 18F-FDG uptake on cardiac PET in post-acute COVID syndrome. Cardiac PET could replace or be added to CMR for detecting subtle subacute/chronic myocarditis. The follow-up of patients with post-acute COVID-19 could target the possibility of risk of heart failure.

Keywords:

• post-acute COVID-19
• cardiac involvement
• laboratory tests
• imaging

Abbreviations

M, Mean; SD, Standard Deviation; NT-BNP, NT-proBNP (pg/mL); TAS, total antioxidant status (mmol Trolox Eq/L); T.O.S, total oxidant status (mmol H₂O₂ Eq/L); OSI, oxidative stress index; (TOS/TAS); PON, Paraoxonase (U/L); TTL, total thiol (µmol/L); NTL, serum native thiol (µmol/L); NO, nitric oxide (µmol/L); LGE, Late gadolinium enhancement imaging.

Data Sharing Statement

The data will not be shared. Due to the restrictions from Medicana International Ankara Hospital, the data are available upon request for any researcher based on a standard agreement on data provision.

Ethics Approval and Consent to Participate

The study protocol adopted the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Medicana International Ankara Hospital Human Research Ethic Committee (2020/13). Written and informed consent was obtained from each participant included in the study.

Acknowledgments

Atılım University Medical School, and Medicana International Ankara Hospital for support of biochemical and imaging tests.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no other potential conflicts of interest for this work and no financial or other relationships that might lead to a conflict of interest. There are no relationships with industry.

Additional information

Funding

This work was supported by Medicana International Ankara Hospital and Atilim University School of medicine. None of the funding sources had an influence on the design or production of the article.