Longitudinal Changes of Cardiac and Aortic Imaging Phenotypes Following COVID-19 in the UK Biobank Cohort

Abstract

Case studies conducted after recovery from acute infection with SARS-CoV-2 have frequently identified abnormalities on CMR imaging, suggesting the possibility that SARS-CoV-2 infection commonly leads to cardiac pathology. However, these observations have not been able to distinguish between associations that reflect pre-existing cardiac abnormalities (that might confer a greater likelihood of more severe infection) from those that arise as consequences of infection. To address this question, UK Biobank volunteers (n=1285; 54.5% women; mean age at baseline, 59.8 years old; 96.3% white) who attended an imaging assessment including cardiac magnetic resonance (CMR) before the start of the COVID-19 pandemic were invited to attend a second imaging assessment in 2021. Cases with evidence of previous SARS-CoV-2 infection were identified through linkage to PCR-testing or other medical records, or a positive antibody lateral flow test; n=640 in data available on 22 Sep 2021) and were matched to controls with no evidence of previous infection (n=645). The majority of these infections were milder and did not involve hospitalisation. Measures of cardiac and aortic structure and function were derived from the CMR images obtained on the cases before and after SARS-CoV-2 infection from images for the controls obtained over the same time interval using a previously validated, automated algorithm. Cases and controls had similar cardiac and aortic imaging phenotypes at their first imaging assessment. Changes between CMR imaging measures in cases before and after infection were not significantly different from those in the matched control group. Additional adjustment for comorbidities made no material difference to the results. While these results are preliminary and limited to imaging metrics derived from automated analyses, they do not suggest clinically significant persistent cardiac pathology in the UK Biobank population after generally milder (non-hospitalised) SARS-CoV-2 infection.

Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus

“…In contrast to these early studies, a subsequent study 128 of healthcare workers, which enrolled co-morbidity matched controls with mild infection, reported a lower prevalence of CMR abnormalities, with no significant difference in 6-month CMR tissue abnormalities between seropositive and seronegative healthcare workers. Similarly, a study of 1285 UK Biobank participants 155 with pre- and post-SARS-CoV-2 infection imaging revealed no link between prior infection and longitudinal changes in cardiac or aortic phenotypes before and after adjusting for potential confounders including co-morbidities.…”

Abdominal imaging associates body composition with COVID-19 severity

“…The UKBB has already provided invaluable insights regarding the prevalence of COVID-19 [ 31 ], as well as its associations with cardiometabolic profiles [ 32 ], frailty [ 33 ], and the ability to predict disease severity [ 34 , 35 ] and mortality [ 36 ]. In contrast to the prevailing literature that COVID-19 can result in a number of cardiovascular disorders [ 37 ], an analysis of cardiac MRI found no significant changes between cases before and after infection, compared to controls, which the authors attributed to generally a milder disease in the UKBB cohort compared to most clinical studies [ 38 ]. However, a brain MRI study from the same UKBB cohort reported multiple changes including loss of gray matter in several regions of the brain associated with the primary olfactory and gustatory systems [ 39 ].…”

Abdominal Imaging Associates Body Composition with COVID-19 Severity

“…Similarly, there are numerous case reports of individual patients which describe changes in organs throughout the body, although these are mostly linked to severe disease, where it is not always clear whether the reported changes relate to viral infection per se, hypoxia/mechanical ventilation or drug treatments. Interestingly, the first longitudinal study of cardiac phenotypes, also using the UKBB dedicated cardiac imaging dataset, reported no significant changes in cases vs controls, which they attributed to a generally higher prevalence of milder/non-hospitalized disease in this population [34]. However, brain MRI in the same cohort revealed significant gray matter loss in several brain areas [35], suggesting that even a non-severe COVID-19 infection can cause changes in the brain.…”

“…The UKBB has already provided invaluable insights regarding the prevalence of COVID-19 [27], as well as its associations with cardiometabolic profiles [28], frailty [29], and the ability to predict disease severity [30,31] and mortality [32]. In contrast to the prevailing literature that COVID-19 can result in a number of cardiovascular disorders [33], an analysis of cardiac MRI found no significant changes between cases before and after infection, compared to controls, which the authors attributed to generally a milder disease in the UKBB cohort compared to most clinical studies [34]. However, a brain MRI study from the same UKBB cohort reported multiple changes including loss of gray matter in several regions of the brain associated with the primary olfactory and gustatory systems [35].…”