CVS scientists shift to COVID-19 cardiovascular research
During the global COVID-19 pandemic, many CVS scientists shifted the focus of their research to coronavirus-related topics.
Several Centre for Cardiovascular Science COVID-19 research projects are detailed below.
Our understanding of the clinical manifestations of COVID-19 is improving with increasing scientific evidence. So far, we know that elderly patients and those with heart problems are susceptible to particularly poor outcomes from this infection. Furthermore, evidence suggests that acute myocardial injury is common and associated with severe illness. The frequency of myocardial injury and the underlying mechanisms of acute myocardial injury in SARS-CoV-2 are currently not well understood, but a range of potential direct and indirect causes are likely to be involved (Figure 1). The indirect consequences of this pandemic on cardiac care may be as important as the direct effects of the infection, as patients with established cardiovascular disease are encouraged to self-isolate to reduce their risk.
Through the use of routinely collected linked electronic health record data and systematic cardiac biomarker testing in this series of cohort studies (COVID – HEART, Figure 2) we aim to evaluate the direct and indirect consequences of COVID-19 on the heart and the provision of acute cardiac care. Our integrated programme of studies will provide generalisable findings to define the true prevalence of acute myocardial injury in COVID-19 and the range of cardiac manifestations associated with this condition. Furthermore, we will provide insight into the indirect consequences of this pandemic and ensure that pressures on the provision of care do not compromise the decades of progress we have made here in improving survival for patients with cardiovascular disease.
- Features of 20 133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study
R4VaD is a UK-wide prospective observational study of cognitive, physical and neuropsychiatric complications after stroke, funded by the Stroke Association, BHF, Alzheimer’s Society, and MRC Dementia Platform UK and led from Edinburgh. It commenced recruitment in Sept 2018, and had recruited 1271 patients at 53 sites by mid-March 2020 when the Sponsor suspended recruitment due to SARS-CoV-2.
R4VaD subsequently obtained approval to continue recruiting during the COVID-19 pandemic. During the early stages of the COVID-19 outbreak, R4VaD had already identified adverse impacts of COVID-19 and social distancing measures on patients up to 12 months after stroke, including high levels of anxiety and major difficulties with social support during introduction of the UK social distancing measures. COVID-19 may be a risk factor for ischaemic stroke, may influence the severity and prognosis of those who present with stroke, and together with the social distancing measures, may affect the long-term recovery and life after stroke. By continuing to recruit through the pandemic, using a streamlined data collection form to reduce burden on patients and researchers, R4VaD aims to compare data collected before, during and after the pandemic, using existing funded infrastructure. It will be one of the few opportunities to obtain objective data on COVID-19 and stroke, including at late stages after stroke.
If you would like any more information about R4VaD, please contact us on email@example.com.
- R4VaD website: https://stroke.nottingham.ac.uk/r4vad/live/r4vad_login.php
- Stroke Association: https://www.stroke.org.uk/research/national-collaborative-study-improve-our-understanding-longer-term-memory-and-thinking
- Alzheimer’s Society: https://www.alzheimers.org.uk/research/our-research/research-projects/investigating-memory-thinking-problems-following-stroke
- Study registration: http://www.isrctn.com/ISRCTN18274006
- Joanna Wardlaw
Diagnosis of COVID-19 is currently made by looking for evidence of the virus’s DNA in a nose swab. Unfortunately, these swabs must go to a laboratory while the patient is held in isolation awaiting results (often >24hrs). A quicker approach is required to both identify/exclude Covid-19 on patients’ arrival to hospital and provide early signals of how the infection is progressing. This will improve patient care and reduce infection of staff.
Exhaled breath contains volatile organic compounds (VOC) that are measured using gas chromatography/ion mobility spectrometry (GC-IMS). Over 100 compounds can be detected, increasing or decreasing in amount depending on processes in lungs and elsewhere in the body. These changes produce a signature that can be detected using GC-IMS in <10 min. Preliminary data suggest an ability to distinguish pneumonia caused by bacteria from pneumonia caused by viruses like the COVID-19 virus.
This study is using a near-patient GC-IMS device (BreathSpec) to study the breath signatures of ≥200 patients presenting to the emergency department of the Royal Infirmary of Edinburgh with a possible diagnosis of COVID-19 lung disease. Breath samples are taken on presentation, and in some patients after admission to determine how the signals change over time. In addition, we plan to take daily breath samples from asymptomatic staff members to determine whether asymptomatic infection can be detected.
Michael Eddleston, R O’Brien, K Darnley, M Reed (Edinburgh), D Ruszkiewicz, CLP Thomas (Loughborough)
Concerns have been raised in published literature, news outlets and social media regarding increased rates of blood clots in patients who have COVID-19. 18F-GP1 is a novel radiotracer that binds to activated platelets, which are essential for clot formation. Early data suggest it may be more sensitive than current techniques at detecting clot in some circumstances. 18F-GP1 imaging therefore may offer a suitable method to examine the posited association between COVID-19 and clots. We aim to undertake 18F-GP1 imaging in patients who have had COVID-19 and evidence of clots (such as heart attacks or lung clots) to explore this relationship, and compare the findings to patients with these conditions who have not had COVID-19.