More insight into heart damage in COVID-19 through research Maastricht UMC +

Thursday 19 May 2022 – 22:10 Update: 19-05-2022 22:11

First corona wave

Since the first wave of the corona pandemic, Maastricht UMC + has been monitoring and researching the heart health of COVID patients admitted to the intensive care unit, through daily cardiac videos and tingling of two essential substances: hs-cTnT and NT-proBNP. These substances indicate damage to the heart muscle and congestion of the heart (heart failure), respectively. By determining these substances daily, the course could be mapped during the entire IC admission. In addition, doctors and researchers from MUMC + also follow these patients after IC admission.

Three releases

This collaboration between intensive care, cardiology and radiology has now resulted in three publications in leading scientific journals. Two of these provide insight into the role of the heart during IC admission, and a publication shows which heart injuries are still visible six months after IC admission.

coronary artery calcification

A CT scan at the beginning of the IC image mapped the calcification of the coronary arteries. This calcification is usually accelerated by risk factors such as smoking, high blood pressure, high cholesterol and obesity. The more calcification, the more vulnerable the heart is to developing a heart attack. The study showed that patients with more coronary artery calcification had a greater chance of organ failure during IC admission.

Heart damage and disease course

There may be circulating substances in the blood that reflect the load on the heart (NT-proBNP) on the one hand and heart muscle damage (hs-cTnT) on the other hand. Analysis of congestion of the heart showed that this drug decreased during hospitalization in individuals who survived IC hospitalization. IC patients who died showed an increase in NT-proBNP during hospitalization. Researchers do not yet know exactly what causes this congestion, so more research is needed. The results suggest that cardiac overload is associated with survival. Finally, patients who died had multiple myocardial infarctions (higher hs-cTnT) when admitted to the intensive care unit.

Rob Driessen, Cardiologist Intensive Care Unit at Maastricht UMC +: ‘In any case, these results show that heart damage and congestion in a COVID patient in the intensive care unit play a major role in the course of the disease. This is an important insight, because the substances studied can probably in the future be used to estimate the course of the disease and to treat the heart in a targeted manner.

Damage after IC recording

Cardiologist in training Chahinda Ghossein-Doha set up the first cardiology outpatient clinic in the Netherlands in the first wave to follow up on patients who survived IC hospitalization. Six months after admission, blood tests, ECG (heart film) and ultrasound and MRI of the heart were performed. These studies show that the drug indicating myocardial infarction is still elevated in almost one third of the patients studied. In addition, 20% have coronary artery disease and 20% have scar tissue on the heart muscle. One in ten patients even has signs of a very rare history of inflammation of the heart muscle or pericardium, myocarditis or pericarditis. 40% of all study participants required medical treatment of the heart or vessels after IC admission.

Follow-up of patients and follow-up

According to Ghossein-Doha, these striking results are: ‘It is a confirmation that it is crucial to closely monitor heart health after IC admission. However, it is still unclear whether these cardiovascular problems are caused by COVID-19 itself, or whether it is a patient population that already had abnormalities that had not yet been diagnosed, giving them a higher risk of a more serious disease course. ‘ To investigate this further, Ghossein-Doha, together with researchers from Utrecht and Amsterdam, has set up the DEFENSE study and has received a ZonMw grant of € 800,000. This study is being conducted at more than 10 Dutch hospitals and will provide more insight into the damage to the heart generated after COVID-19.

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