Symptom burden, coagulopathy and heart disease after acute SARS-CoV-2 infection in primary practice

Abstract

SETANTA (Study of HEarT DiseAse and ImmuNiTy After COVID-19 in Ireland) study aimed to investigate symptom burden and incidence of cardiac abnormalities after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 and to correlate these results with biomarkers of immunological response and coagulation. SETANTA was a prospective, single-arm observational cross-sectional study condcuted in a primary practice setting, and prospectively registered with ClinicalTrials.gov (identifier: NCT04823182). Patients with recent COVID-19 infection (≥ 6 weeks and ≤ 12 months) were prospectively enrolled. Primary outcomes of interest were markers of cardiac injury detected by cardiac magnetic resonance imaging (CMR), which included left ventricular ejection fraction, late gadolinium enhancement and pericardial abnormalities, as well as relevant biomarkers testing immunological response and coagulopathy. 100 patients (n = 129 approached) were included, amongst which 64% were female. Mean age of the total cohort was 45.2 years. The median (interquartile range) time interval between COVID-19 infection and enrolment was 189 [125, 246] days. 83% of participants had at least one persistent symptom, while 96% had positive serology for prior SARS-CoV-2 infection. Late gadolinium enhancement, pericardial effusion, was present in 2.2% and 8.3% respectively, while left ventricular ejection fraction was below the normal reference limit in 17.4% of patients. Von Willebrand factor antigen was elevated in 32.7% of patients and Fibrinogen and D-Dimer levels were found to be elevated in 10.2% and 11.1% of patients, respectively. In a cohort of primary practice patients recently recovered from SARS-CoV-2 infection, prevalence of persistent symptoms and markers of abnormal coagulation were high, despite a lower frequency of abnormalities on CMR compared with prior reports of patients assessed in a hospital setting.Trial Registration: Clinicaltrials.gov, NCT04823182 (prospectively registered on 30th March 2021).

Keywords: Biomarkers; COVID-19; Inflammation; Magnetic resonance imaging.

Fig. 1

Cardio-respiratory symptoms following SARS-CoV-2 diagnosis. This figure highlights the percentages of patients with cardiorespiratory symptoms.

Fig. 2

(A) Responses for modified version of SAQ7 (Seattle Angina Questionnaire, short form) at baseline, 6 months and 12 months follow-up. Individual panels highlight responses to each question at baseline, 6-month follow up and 12 month follow up. Note that as these were otherwise healthy patients, without a diagnosis of ischemic heart disease, and not prescribed regular or as required nitroglycerin, the question with regard to nitroglycerin was omitted. (B) Responses for EQ-5D-5L (EuroQol 5-dimension 5 level) quality-of-life questionnaire at baseline, 6 months and 12 months follow-up. Individual panels highlight responses to each question at baseline, 6-month follow up and 12 month follow up. The final panel displays the mean overall “Health Score” at baseline, 6 months and 12 months.

Fig. 3

SETANTA study highlights.