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Rapid Fire Abstracts

Rapid Fire 06- Multi-Center Trials and Epidemiological Studies

Impact of Age and Sex on Myocardial Involvement in hospitalized COVID-19 patients: A Pre-specified Subanalysis of COVID-HEART (RF_FR_331)

Friday, January 31, 2025
11:00 AM – 11:10 AM East Coast USA Time
Location: Blue Room PreFunction
Background:

COVID-HEART was a prospective, longitudinal, multicenter, observational cohort study of patients hospitalized with COVID-19 and elevated serum troponin in the United Kingdom. From a pre-specified subanalysis, we evaluated and compared the interaction of age and sex with CMR abnormalities in COVID-19 inpatients and contemporary controls.

Methods:

Patients recruited to COVID-HEART and contemporary controls were included and divided into three groups (COVID-19 positive, troponin positive inpatients; COVID-19 positive inpatients with non-elevated serum troponin; and non-hospitalized, age and sex-matched controls). The impact of age and sex on cardiac abnormalities (left and right ventricular systolic function, pericardial effusion, and myocardial scarring) and myocardial inflammation on CMR was assessed in linear or logistic regression models, and odds ratios (OR) with 95% confidence intervals along with the corresponding p-values for interaction reported.

Results:

Of 519 individuals in COVID-HEART (n=342 cases and n=177 controls), 163 (31.4%) were females, of which 99 (60.7%) were hospitalized with COVID-19 and elevated serum troponin. Median age (IQR) was 61 (54-69) years. CMR abnormalities were not dependent on patient age (p-interaction = 0.5) and were more frequent in males (72% vs 60%, p-interaction < 0.001. Overall, a higher prevalence of macroscopic infarction was observed in males (16% in males vs 5.3% in females, p-interaction = 0.002). Comparable proportions of males and females had microinfarction (9.2%), non-ischemic scar (12.0%), or dual pathology (2.5%) patterns. The microinfarct pattern was exclusively identified among hospitalized patients irrespective of age and sex. No differences in the proportion of patients with LV systolic impairment or pericardial effusion were identified. Females had significantly higher myocardial inflammation detected by global T2 values (Z-score 0.56 vs -0.07, p < 0.0001), while no age-related differences were detected in global T1 or T2 values. At clinical follow-up, no differences were observed in major adverse cardiovascular event rates between males (15.0%) and females (9.1%, p-interaction = 0.3).

Conclusion: COVID-19 affected the heart differently in males and females, with no major differences noted attributable to age. A greater proportion of male patients was found to have an ischemic scar during the acute infection, while microinfarction and other scar patterns were similarly prevalent between sexes.