Cardiovascular involvement in coronavirus disease-2019 (COVID-19) encompasses a wide range of vascular and myocardial pathologies, including both acute and long-term sequelae. The MIIC-MI study aims to investigate mechanisms of cardiac injury in COVID-19 using multi-modality imaging and immunophenotyping to better understand the link with adverse patient outcomes.
Cardiovascular involvement in coronavirus disease-2019 (COVID-19) encompasses a wide range of
vascular and myocardial pathologies, including both acute and long-term sequelae.
Cardiac Troponin elevation, a marker of acute myocardial injury, has been identified in up to
28% of hospitalized patients with coronavirus disease 2019 (COVID-19) and is associated with
an increased mortality risk. However, the predominant aetiology of myocardial injury relating
to COVID-19 remains unclear. The Troponin leak could either signify direct cardiac
involvement in COVID-19 or serve as a non-specific marker of a severe systemic insult.
There have been numerous reports of acute myocarditis in patients with COVID-19. Other
contributory mechanisms of cardiac Troponin elevation in patients with COVID-19 that are also
driven by a proinflammatory state include acute myocardial infarction due to atherosclerotic
plaque rupture (type 1) or demand ischemia (type 2), endothelial and microvascular
dysfunction, immune-mediated activation of coagulation and fibrinolytic systems, and stress
cardiomyopathy.
Longer-term effects of COVID-19 on the cardiovascular system are also unknown. Many
individuals with post-acute sequalae of SARS-CoV-2 infection (or 'long COVID') have
unexplained cardiac symptoms. Patients may also present with new-onset heart failure after
COVID-19, which is not attributed to another cause.
We aim to identify patterns of myocardial injury in COVID-19 using non-invasive
multi-modality cardiac imaging, paired with cytokine/chemokine testing, immunophenotyping of
peripheral blood cells and coagulation profiles.
A better understanding of the mechanisms underlying the excess mortality risk attributable to
myocardial injury in COVID-19 is needed and may help to improve patient care.
Diagnostic Test: Non-invasive cardiac imaging
Cardiac MRI ± CT coronary angiography ± Cardiac PET/MRI (68Ga-DOTATATE or 18F-FDG)
Inclusion Criteria:
- Patients >18 years old
- Confirmed COVID-19 infection AND Troponin I elevation >99th percentile of upper
reference limit OR new-onset heart failure OR unexplained cardiac symptoms
- Able to give written, informed consent
Exclusion Criteria:
- Women of child-bearing potential not using adequate contraception
- Contra-indication to MRI scanning
- Contrast allergy or contrast-nephropathy
- Chronic kidney disease (eGFR <30 mL/min/1.73 m2)
- Previous myocardial infarction
- Uncontrolled atrial fibrillation
- Uncontrolled chronic inflammatory disease
- Severe lymphopenia (<0.2 x109/L)
- Treatment with immunomodulatory therapies within the last month (excluding inhaled or
topical steroid therapy)
- Any medical condition, in the opinion of the investigator, that prevents the
participant from lying flat during scanning, or from participating in the study
Cambridge Univeristy Hospitals NHS Foundation Trust
Cambridge, United Kingdom
Jason M Tarkin, MBBS, PhD, Principal Investigator
University of Cambridge