Demographic, multi-morbidity and genetic impact on myocardial involvement and its recovery from COVID-19: the COVID-HEART study

COVID-HEART is a large UK multi-centre consortium committed to work together to answer a set of unique and important clinical questions. The bid is backed by the major UK professional cardiovascular societies and the NIHR-BHF Cardiovascular Partnership have designated it as a "COVID-19 Cardiovascular Disease UK Flagship Project" (see attached letter). Whilst up to 20% of hospitalised COVID-19 patients may have cardiac injury based on serum troponin (and associated with high mortality), this is non-specific and can relate to pericarditis, myocarditis, acute coronary syndromes, acute heart failure, arrhythmias, or simply hypoxia/sepsis/shock. Cardiovascular magnetic resonance (CMR) can make a specific diagnosis and is recommended in European Society of Cardiology practice guidelines. We will use CMR to determine 1) the UK prevalence of acute myocardial injury/myocarditis secondary to COVID-19 and the severity of presentation; 2) how clinical outcomes associate with recognised risk factors for mortality such as age, sex, ethnicity and comorbidities (diabetes, hypertension, heart failure, and coronary/peripheral vascular disease; 3) if there are differences in myocardial recovery at 6 months dependent on demographics, genetics and comorbidities, and how this impacts on patient quality of life and functional capacity; 4) if we can improve the ECG diagnosis of myocarditis minimising the requirement for invasive cardiac investigations. Ethics approval has been granted for clinical CMR scans enabling us to start quickly, and if funded we would extend this approval to include the additional research scans, other investigations, patient reported outcome measures and follow-up as described below.