First corona wave
Since the first wave of the corona pandemic, Maastricht UMC+ has been monitoring and investigating the heart health of COVID patients admitted to ICU, through daily heart videos and the pricking of two essential substances: hs-cTnT and NT-proBNP. These substances indicate damage to the heart muscle and overload of the heart (heart failure), respectively. By determining these substances daily, the course could be mapped out during the entire IC admission. In addition, doctors and researchers of the MUMC+ also follow these patients after IC admission.
Three publications
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 one publication shows which heart damage is still visible six months after IC admission.
coronary artery calcification
A CT scan at the start of the IC image mapped the calcification of the coronary arteries. This calcification is normally accelerated by risk factors such as smoking, high blood pressure, high cholesterol and obesity. The more calcification, the more vulnerable the heart to developing a heart attack. The study showed that patients with more coronary artery calcification had a greater chance of organ failure during the IC admission.
Heart damage and disease course
Substances can circulate 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. Analysis of overload of the heart showed that this substance decreased during the admission in people who survived the IC admission. The IC patients who died showed an increase in NT-proBNP during admission. The researchers do not yet know exactly what causes this overload, so more research is needed. The results do suggest that cardiac overload is associated with survival. Finally, patients who died had more heart muscle damage (higher hs-cTnT) when admitted to the intensive care unit.
Rob Driessen, cardiologist intensivist at Maastricht UMC+: ‘In any case, these results show that damage to the heart and overload in a COVID patient in the ICU plays a major role in the course of the disease. This is an important insight, because the substances studied can probably be used in the future 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 patients who survived IC admission. Six months after admission, blood tests, an EKG (heart film) and an ultrasound and MRI of the heart were performed. These studies show that the substance that indicates heart muscle damage 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 participants in the study required medical treatment of the heart or vessels after IC admission.
Follow-up of patients and follow-up
According to Ghossein-Doha, these are striking findings: ‘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 concerns a patient population that already had abnormalities that had not yet been diagnosed, which puts them at higher risk of a more serious disease course.’ To further investigate this, Ghossein-Doha has set up the DEFENCE study together with researchers from Utrecht and Amsterdam and has received a ZonMw grant of €800,000 for this. This study is being conducted in more than 10 Dutch hospitals and will provide more insight into damage to the generate heart after COVID-19.
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