CardiOvaScular Mechanisms In Covid-19: methodology of a prospective observational multimodality imaging study (COSMIC-19 study)

• Type of Material: Article
• Authors: Shirjel R. Alam, University of Manchester; Anoop S. V. Shah, London School of Hygiene & Tropical Medicine; Kevin O. Ombati, Aga Khan University; Edward Nganga, Aga Khan University; Samuel Gitau, Aga Khan University; Khalid Makhdomi, Aga Khan University; Michael Chung, Emory University; Sudhir Vinayak, Aga Khan University
• Language: English
• Date: 2021-05-08
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12872-021-02027-0
• Title of Journal or Parent Work: BMC CARDIOVASCULAR DISORDERS
• Volume: 21
• Issue: 1
• Start Page: 234
• End Page: 234
• Grant/Funding Information: Anoop Shah is funded via the British Heart Foundation through an Intermediate Clinical Research Fellowship (FS/19/17/34172). The project imaging is funded by the Scottish Funding Council—Global Challenged Research Fund. The funding source has estimated the feasibility of the study, but has no role in the collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication.
• Keywords: INFLAMMATION; MAGNETIC-RESONANCE; COMPUTED-TOMOGRAPHY; MRI; Cardiovascular; ACUTE MYOCARDIAL-INFARCTION; Troponin; 18F-FDG-PET/CT; Life Sciences & Biomedicine; CTCA; Cardiac injury; COVID-19; CORONARY-ARTERY-DISEASE; INJURY; ATHEROSCLEROSIS; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; Science & Technology; POSITRON-EMISSION-TOMOGRAPHY; RISK; Imaging; CMR; FDG
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Background: 8–28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-d-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections. Methods: This is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA and 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels. Discussion: The results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic. Trial Registration: This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at https://www.isrctn.com/ISRCTN12154994