None listed
Conditions
Brief summary
This is a longitudinal observation study which is evaluating the association of hospitalised community-acquired pneumonia with (i) myocardial fibrosis and with (ii) new-onset left ventricular dysfunction. An abundance of epidemiological data strongly associates pneumonia and subsequent new-onset heart failure, however the mechanism is unclear. Experimental animal data suggest that bacterial invasion of the myocardium with resulting cardiac fibrosis could be implicated. In a recent exploratory study of 20 adults with bacterial community-acquired pneumonia, highly-selected to ensure no prior history of any heart disease, we reported the highly novel finding of myocardial fibrosis and new-onset left ventricular dysfunction in 30% and 5% respectively (Rajwani et al, Bacterial pneumonia is associated with myocardial fibrosis and new-onset left ventricular dysfunction, JACC Advances 2022, in press). If this novel finding of a pathophysiological process in the myocardium is replicated in larger studies of pneumonia, this could herald a major paradigm shift in the post-discharge care of pneumonia. In this current larger study, adults free of prior heart disease who are hospitalised with community-acquired pneumonia (except those with positive viral nucleic acid amplification assay at admission) will be recruited. Myocardial function and composition will be assessed during convalescence post-discharge, as well as longer-term clinical outcomes for heart failure. Predictors of myocardial fibrosis will also be evaluated, in order to allow enrichment of future translational studies exploring preventative strategies.
Interventions
This observational study will recruit adult participants hospitalised due to community-acquired pneumonia who do not have exclusion criteria.
Enrolled participants will undergo a single cardiac magnetic resonance imaging (CMR) during convalescence (2-4 weeks after discharge from hospital) for assessment of myocardial function and composition. This will be performed using a 1.5T magnet under the supervision of a consultant cardiologist with Level III accreditation of training. The anticipated du
This observational study will recruit adult participants hospitalised due to community-acquired pneumonia who do not have exclusion criteria. Enrolled participants will undergo a single cardiac magnetic resonance imaging (CMR) during convalescence (2-4 weeks after discharge from hospital) for assessment of myocardial function and composition. This will be performed using a 1.5T magnet under the supervision of a consultant cardiologist with Level III accreditation of training. The anticipated duration of the imaging procedure is approximately 40 minutes. Gadolinium-based contrast will be administered intravenously at 0.15mmol per kg body weight. Images will be analysed by 2 blinded observers independently, both of whom are consultant cardiologists holding Level 3 accreditation of training in CMR. The CMR protocol will include: 1. Steady-state-free-precession (SSFP) cine images including the 3 major long axes and short-axis stack for quantification of chamber volumes, stroke volume and ejection fraction. 2. Myocardial oedema assessment by T2-weighted imaging and T2-mapping (qualitative and quantitative assessments respectively). 3. T1 weighted late gadolinium imaging (same planes as SSFP). 4. T1-mapping pre and post contrast for quantification of extra-cellular volume as per the standard protocols prescribed by the Society of Cardiovascular Magnetic Resonance consensus statement (Messroghli et al, JCMR 2017). Blood samples will also be collected from participants, and will be assessed for biomarkers including C-reactive protein, brain natriuretic peptide and high-sensitivity troponin I. These samples will be collected at admission, peri-discharge, and at the time of the CMR 2-4 weeks post-discharge. Clinical assessment will also be performed by a study clinician or nurse by telephone interview at 1 year, 2 years and 5 years post index hospitalisation for community-acquired pneumonia. Where a significant clinical event is noted (death, new prescription of a loop-diuretic, hospital admission, emergency department presentation), review of the hospital or primary care notes will be conducted for further clinical details.
Sponsors
Dr Adil Rajwani
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
(i) Adults hospitalised with community-acquired pneumonia (meeting American Thoracic Society criteria in terms of clinical presentation and radiological features); (ii) Capacity to provide written informed consent.
Exclusion criteria
Viral pneumonia, based on the detection of viral nucleic acid amplification on admission screening for pneumonia pathogens. Prior clinical history of coronary artery disease, myocarditis, connective tissue disorders, cardiomyopathy, heart failure, or pre-existing requirement for loop diuretics. Left ventricular ejection fraction <54% (women) or <52% (men) at baseline echocardiogram. Contraindications to contrast-enhanced CMR including prohibitive implanted ferromagnetic devices, pregnancy, severe claustrophobia, and chronic kidney disease with estimate glomerular filtration rate <=30ml/min/1.73msq.
Outcome results
None listed