An observational study of consecutive patients testing positive for COVID-19 who require admission to hospital to determine the degree of myocardial injury through biomarkers and echocardiography and the impact of this on cardiovascular outcomes. The COVID-19 disease and CARdiac Events study (COVICARE).
Purposes:
1. To determine the prevalence of myocardial injury/impairment in patients hospitalised
with COVID-19 disease.
2. To determine the predictive value of baseline biomarkers in identifying patients at high
risk of significant morbidity/mortality due to COVID-19.
Justification:
The Novel Coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), first
recorded in Hubei Province of Wuhan China in December 2019 has now swept the globe and has
been declared a pandemic by the World Health Organisation.
The largest published registry from the Chinese centre for disease control and prevention
(CDC) describes a disease with a broad range of acuity but found from a cohort of 72314
confirmed or suspected cases (72314) 14% of those affected required hospitalisation and 5%
required critical care. Thus far treatment has focused on quarantine and supportive care.
Predicting outcomes in COVID disease requires risk stratifying infected patients. Data so far
have mainly come from small studies in China but the consistent risk factors appear to be
advanced age, diabetes, hypertension and cardiovascular disease. The CDC report a 10.5% risk
of death associated with underlying cardiovascular disease, surprisingly more than those with
respiratory disease, especially given that lung involvement is the dominant clinical
presentation. The reason for poor outcome in cardiovascular disease is unknown but is likely
to be multifactorial. A literature search of nine observational studies reported myocardial
injury based on high sensitivity troponin, abnormal ECG, abnormal echocardiogram or a
combination of the three. The reported rate of myocardial injury ranged from 7-28% and in all
groups was associated with higher rates of requirement for critical care. Mortality was
increased compared to those without myocardial injury- 51.2% vs 4.5%.
Trial overview:
Patients admitted to University Hospital Hairmyres (UHH) with confirmed COVID-19 will have 3
biomarkers - high sensitivity troponin T (hsTnT), N-terminal (NT)-proBNP and ferritin - added
on retrospectively to their admission blood samples, and an additional sample will be taken
for cytokine analysis.
An ECG and echocardiogram will be performed.
Patients will be observed during the remainder of the hospitalisation and for up to 30 days
from admission for major adverse cardiac events.
Statistical analysis:
The prevalence of echocardiographic abnormalities in the cohort will be presented.
Biomarker levels will be compared between patients who require intensive treatment unit (ITU)
admission or not, ventilation or not or who die or survive up to 30 days using independent
samples t-tests if the data are normally distributed or Mann-Whitney-U tests if non normally
distributed.
Inclusion Criteria:
1. Age ≥ 18 years
2. In-patient in UHH within first 5 days of admission
3. COVID-19 disease confirmed on rtPCR detection of SARS-CoV-2 from nasopharyngeal swabs
and/or thoracic X-ray imaging findings characteristic of COVID-19 disease (positive
swab results preferred).
4. Able to provide written, informed consent.
Exclusion Criteria:
1. Refusal of consent for enrolment.
2. Known pre-existing left ventricular systolic dysfunction with left ventricular
ejection fraction (LVEF) <40%.
University Hospital Hairmyres
Glasgow, Scotland, United Kingdom
Robin A Weir, MD, Principal Investigator
NHS Lanarkshire