Project Summary/Abstract: While primary manifestations of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection involve the respiratory system, acute myocardial injury occurs as frequently up to 27%, and the 30-day mortality rate is substantially higher in patients with myocardial injury (51.2%) than those without injury (4.5%). Another disturbing trend is the disproportionate impact of COVID-19 on the black population across the US. In Chicago, blacks (30.1% of population) account for 50.5% of COVID-19 patients and 69.6% of COVID-19 deaths. These statistics highlight the need to establish the overall prevalence, mechanism, severity, and extent of cardiac injury associated with SARS-CoV-2 and investigate factors contributing to such glaring health disparities associated with COVID-19. Our primary hypothesis is that acute myocardial injury is more prevalent, extensive, and severe in hospitalized patients with COVID-19 compared to matched hospitalized patients with ORV. Furthermore, we hypothesize that acute myocardial injury associated with SARS-CoV-2 is worse in blacks than whites. To test these hypotheses, we propose to conduct a case-control study comparing hospitalized patients with COVID-19 to hospitalized patients with ORV matched for sex, age, race, viral pneumonia risk score (MuLBSTA), and pre- existing heart disease (coronary artery disease or heart failure). We will enroll equal numbers of whites and blacks to determine factors contributing to racial health disparities in patients with COVID-19. Cardiovascular magnetic resonance (CMR) is the ideal “one-stop-shop” imaging test for phenotyping patients with virus-mediated cardiac injury associated with multiple pathways and manifestations. This approach affords comprehensive assessment of injury, including evaluation of inflammation, necrosis or scar, diffuse fibrosis, contractile function, and hemodynamics. The image quality of a standard CMR, however, may be unacceptable in hospitalized COVID-19 patients due to two fundamental methodologic deficiencies: (a) lengthy (~60 min) scan time which is too long for sick patients; (b) severe image artifacts caused by dyspnea (55%), arrhythmia (16.7%) and alveolar infiltrates (off-resonance). Leveraging our access to a library of rapid, wideband, arrhythmia-insensitive, free-breathing CMR pulse sequences that were developed for the parent study (R01HL151079), we are in a unique position to perform a rapid (20 min) free-breathing CMR to phenotype this cohort who otherwise may not be considered for CMR. The specific objectives of this study are: (a) to determine whether acute myocardial injury differs significantly between COVID-19 and ORV patients; (b) to determine whether cardiac injury differs across race and correlates with social determinants of health; (c) to determine whether the severity of cardiac injury correlates with the degree of lung injury as assessed with chest X-ray and MuLBSTA. This proposal has high potential impact because new discoveries of cardiac injury and racial disparities will serve as the requisite evidence for pursuing future therapeutic studies.

PROJECT NARRATIVE: This supplemental study seeks to apply a fast magnetic resonance imaging (MRI) approach developed by the parent study (R01HL151079) for evaluating injury to the heart associated with the coronavirus disease of 2019 (COVID-19). The objectives of this study are to determine whether injury to the heart is worse in patients with COVID-19 than those with the common flu and whether injury to the heart and social determinants of health are contributing to worse racial health disparities associated with COVID-19. Improved understanding of injury to the heart and factors contributing to racial health disparities will inform strategies for managing for patients with COVID-19 for all races and reducing COVID-19 deaths in the black population, respectively.