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Post-COVID Heart Problems Are Real, Despite Study Corrections

— Conclusions still stand, group says after fixing a raft of data errors

Last Updated August 27, 2020
Ƶ MedicalToday
Cardiac magnetic resonance imaging technologists observe a patient during a cardiac MRI scan

Corrections to a after COVID-19 recovery, , didn't alter the overall conclusions.

The study from Germany had been for using inaccurate metrics for the data analysis, as well as inconsistencies internally in the paper.

For example, "the fact that it's not just one but literally dozens of similarly implausible data points suggests that the most generous interpretation of their work is " tweeted David Cohen, MD, of Kansas City, Missouri.

After reviewing the data and repeating analysis, Eike Nagel, MD, and Valentina O. Puntmann, MD, PhD, both of University Hospital Frankfurt, published a .

While various points changed, like correctly reporting means (SDs) or medians (interquartile ranges) and recalculation of all percentages for the risk-matched controls, the statistical effect was relatively minor, they noted.

"We are pleased to confirm that reanalysis of the data has not led to a change in the main conclusions of the study," they wrote. "As we originally reported, compared with healthy controls and risk factor-matched controls, patients recently recovered from COVID-19 had lower left ventricular ejection fraction, higher left ventricle volume, and elevated values of T1 and T2."

Only the comparison for left ventricular mass index between COVID-19 patients and healthy controls changed from a significant to a nonsignificant association.

Darrel Francis, MD, of the National Heart and Lung Institute of Imperial College London, had criticized the journal for dragging its feet since original publication on July 27.

"I am delighted that this, the most important cardiology paper of the decade, according to the 9000+ , is going to be corrected," he told Ƶ.

The study "has been referenced thousands of times to shut down the #Big10 and #PAC12 seasons by media including @espn," .

How COVID-19 affects the heart long-term is a "very relevant" clinical question, too, noted Behnood Bikdeli, MD, of Brigham and Women's Hospital and Harvard in Boston.

However, the small differences affirmed after the corrections probably aren't a big problem, Francis .

"The revised Jama Cardio paper is brilliant. It's an all-clear! The interesting features on the scans in Covid survivors are real, but they are caused by the risk factors, not by the covid," he tweeted.

High-sensitivity troponin T and high-sensitivity C-reactive protein as markers of cardiac injury and inflammation, respectively, were both significantly higher in the COVID-recovered patients than controls but still within the normal range.

"This paper gives a very nice clearing of people who have had Covid WITH SYMPTOMS SO MUCH THAT THEY STILL HAD TO HAVE AN MRI SCAN to participate in sport," Francis tweeted, adding that "the paper is A-OK for a good recovery from even rather nasty Covid."

Still, the extent of corrections required for this paper should prompt a little soul searching at journals, Bikdeli suggested.

"In the context of COVID-19 and the pandemic, sometimes papers that are interesting go past the peer review so quickly that obvious errors are being missed," he said. Except in the few cases of immediately actionable clinical trial results, "it might be best for all of us, including myself as a reviewer and an editor, to take our time and make sure of the robustness of the results. Of course, it's easier said than done."

Disclosures

Nagel disclosed grants from Bayer, the German Ministry for Education and Research, Deutsche Herzstiftung e.V., Neosoft Technologies, and the Cardio-Pulmonary Institute, as well as personal fees from Bayer. Puntmann disclosed no relevant relationships with industry.

Primary Source

JAMA Cardiology

Nagel E, Puntmann VO "Errors in statistical numbers and data in study of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19" JAMA Cardiol 2020; DOI: 10.1001/jamacardio.2020.4661.