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

  1. Wenjia Bai
  2. Betty Raman
  3. Steffen E. Petersen
  4. Stefan Neubauer
  5. Zahra Raisi-Estabragh
  6. Nay Aung
  7. Nicholas C Harvey
  8. Naomi Allen
  9. Rory Collins
  10. Paul M. Matthews

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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.

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    SciScore for 10.1101/2021.11.04.21265918: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of our study is that all cardiac and aortic measurements were performed using fully automated image segmentation, although the method was validated previously using UK Biobank data16,17. The population studied also is limited to volunteers from amongst UK Biobank participants. The extent to which findings can be generalised particularly to more severe cases of COVID-19 is unknown. As noted above, the exploratory comparison between hospitalised and non-hospitalised infections is based on a small number of hospitalised cases, although the numbers are similar to those in some of the previous case series reporting abnormalities after COVID-194. Finally, the analyses have only considered structural and functional CMR measures. Additional analyses ongoing that will incorporate other cardiac functional data (e.g., ECG) and more detailed examinations of cardiac phenotypes (SEP, unpublished current investigations) could identify longitudinal case-control differences not detected here. Nonetheless, our observations suggest that persistent, clinically significant cardiac complications of SARS-CoV-2 infection are not common in the middle-aged to older UK participants in this UK Biobank pre- and post-infection imaging study.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.11.04.21265918v1 on medRxiv