Cardiac abnormalities detected by echocardiography and cardiac magnetic resonance in healthcare professionals recovered from non-severe COVID-19

Fijałkowska, Jadwiga; Sobolewski, Jakub; Glińska, Anna; Pisowodzka, Izabela; Nowak, Radosław; Żarczyńska-Buchowiecka, Marta; Pieńkowska, Joanna; Gruchała, Marcin; Szurowska, Edyta; Dorniak, Karolina; Fijałkowski, Marcin

doi:10.33963/kp.a2021.0114

Cited by 3 publications

(10 citation statements)

References 7 publications

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“…Moreover, we do not present CMR mapping as it was unavailable at all CMR centers. Still, T1/T2/ECV CMR mapping and LV strain were mostly consistent with conventional CMR sequences [20,22,23,41]. Finally, all the study patients had clinical indications for CMR, which constitutes a potential selection bias.…”

Section: Limitationssupporting

confidence: 63%

A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: A multicenter cardiovascular magnetic resonance study

et al. 2023

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Background: COVID-19 is a great medical challenge as it provokes acute respiratory distress and has pulmonary manifestations and cardiovascular (CV) consequences. Aims:This study compared cardiac injury in COVID-19 myocarditis patients with non-COVID-19 myocarditis patients.Methods: Patients who recovered from COVID-19 were scheduled for cardiovascular magnetic resonance (CMR) owing to clinical myocarditis suspicion. The retrospective non-COVID-19 myocarditis (2018-2019) group was enrolled (n = 221 patients). All patients underwent contrast-enhanced CMR, the conventional myocarditis protocol, and late gadolinium enhancement (LGE). The COVID study group included 552 patients at a mean (standard deviation [SD]) age of 45.9 (12.6) years.Results: CMR assessment confirmed myocarditis-like LGE in 46% of the cases (68.5% of the segments with LGE <25% transmural extent), left ventricular (LV) dilatation in 10%, and systolic dysfunction in 16% of cases. The COVID-19 myocarditis group showed a smaller median (interquartile range [IQR]) LV LGE (4.4% [2.9%-8.1%] vs. 5.9% [4.4%-11.8%]; P <0.001), lower LV end-diastolic volume (144.6 [125.5-178] ml vs. 162.8 [136.6-194] ml; P <0.001), limited functional consequence (left ventricular ejection fraction, 59% [54.1%-65%] vs. 58% [52%-63%]; P = 0.01), and a higher rate of pericarditis (13.6% vs. 6%; P = 0.03) compared to non-COVID-19 myocarditis. The COVID-19-induced injury was more frequent in septal segments (2,3,14), and non-COVID-19 myocarditis showed higher affinity to lateral wall segments (P <0.01). Neither obesity nor age was associated with LV injury or remodeling in subjects with COVID-19 myocarditis.Conclusions: COVID-19-induced myocarditis is associated with minor LV injury with a significantly more frequent septal pattern and a higher pericarditis rate than non-COVID-19 myocarditis.

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Section: Limitationssupporting

confidence: 63%

A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: A multicenter cardiovascular magnetic resonance study

et al. 2023

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“…Twenty-one studies fulfilled the inclusion criteria (Table 1 , Ref. [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]). Seventeen were prospective, 3 were retrospective, and 1 cross-sectional.…”

Section: Resultsmentioning

confidence: 99%

“…Non-ischemic mechanisms include myocarditis, systemic hyperinflammation, hypoxic injury due to severe respiratory infection, and down regulation of ACE2 receptors. All nine studies which separated cardiac injury into non-ischemic and ischemic causes reported a greater prevalence of non-ischemic injury [20,22,24,28,29,32,35,36,38] suggesting that thrombosis and endothelial damage driven cardiac injury is less likely in COVID-19 associated cardiac injury. While Thornton et al [35] reported the prevalence ischemic injury in their cohort to be 17%, they concluded ---Yes Yes Hanneman [25] Yes Yes Yes Yes -Kotecha [28] Yes Yes -Yes Yes Breitbart [20] ---Yes Yes Karaaslan [27] ---Yes -Fijalkowska [22] Yes Yes Yes Yes Yes Cassar [21] Yes No No Yes Yes Altay [19] No No No Yes Yes Ulloa [36] No Yes No Yes No >3 Months (1566 patients) D. Li [30] Yes Yes -Yes -Kravchenko [29] No No No No No Wang [37] No --Yes -Hanneman [25] No No No --X. Li [31] Yes -Yes -Yes Myhre [32] No No No No No Cassar [21] No No No No Yes Fu [23] -----Joy [26] No No No No No Wu [39] No -No Yes -Peterson [33] Yes No -No -"Yes" refers to presence of the CMR finding; "No" refers to absence of the CMR finding; "-" refers to an unreported CMR findings.…”

Section: Mechanism Of Cardiac Injurymentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging of COVID-19-Associated Cardiac Sequelae: A Systematic Review

Boparai¹,

Musheyev²,

Khan³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Many COVID-19 survivors experience persistent COVID-19 related cardiac abnormalities weeks to months after recovery from acute SARS-CoV-2 infection. Non-invasive cardiac magnetic resonance (CMR) imaging is an important tool of choice for clinical diagnosis of cardiac dysfunctions. In this systematic review, we analyzed the CMR findings and biomarkers of COVID-19 related cardiac sequela after SARS-CoV-2 infection. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), we conducted a systematic review of studies that assessed COVID-19 related cardiac abnormalities using cardiovascular magnetic resonance imaging. A total of 21 cross-sectional, case-control, and cohort studies were included in the analyses. Results: Ten studies reported CMR results <3 months after SARS-CoV-2 infection and 11 studies >3 months after SARS-CoV-2 infection. Abnormal T1, abnormal T2, elevated extracellular volume, late gadolinium enhancement and myocarditis was reported less frequently in the >3-month studies. Eight studies reported an association between biomarkers and CMR findings. Elevated troponin was associated with CMR pathology in 5/6 studies, C-reactive protein in 3/5 studies, N-terminal pro-brain natriuretic peptide in 1/2 studies, and lactate dehydrogenase and D-dimer in a single study. The rate of myocarditis via CMR was 18% (154/868) across all studies. Most SARS-CoV-2 associated CMR abnormalities resolved over time. Conclusions: There were CMR abnormalities associated with SARS-CoV-2 infection and most abnormalities resolved over time. A panel of cardiac injury and inflammatory biomarkers could be useful in identifying patients who are likely to present with abnormal CMR pathology after COVID-19. Multiple mechanisms are likely responsible for COVID-19 induced cardiac abnormalities.

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“…Because of its exceptional combination of morphological and functional assessment with myocardial tissue characterization, CMR is an optimal imaging modality for detecting the typical signs of acute myocardial inflammation, such as contraction abnormalities, edema, hyperemia, and fibrosis. Although the current "Lake Louise Criteria" (LLC), [4] recently updated to include contemporary parametric techniques [5] for CMRbased diagnosis of myocarditis, have been well evaluated, additional parameters could improve the accuracy and precision of the diagnosis [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…In our previous study, we evaluated the myocardial injury detected by TTE and CMR in healthcare workers recovering from non-severe COVID-19 [6]. Left ventricular ejection fraction was reduced in 29% of these cases as assessed by both TTE and CMR, and global LV longitudinal strain as assessed by echo was also slightly reduced in 39% of the subjects.…”

mentioning

confidence: 99%

Cardiac Magnetic Resonance Relaxometry Parameters, Late Gadolinium Enhancement, and Feature-Tracking Myocardial Longitudinal Strain in Patients Recovered from COVID-19

Fijałkowska

Glińska

Fijałkowski

et al. 2023

JCDD

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COVID-19 infection is associated with myocarditis, and cardiovascular magnetic resonance (CMR) is the reference non-invasive imaging modality for myocardial tissue characterization. Quantitative CMR techniques, such as feature tracking (FT) and left ventricular global longitudinal strain (GLS) analysis, have been introduced as promising diagnostic tools to improve the diagnostic accuracy of suspected myocarditis. The aim of this study was to analyze the left ventricular global longitudinal strain (GLS) and the influence of T1 and T2 relaxation times, ECV, and LGE appearance on GLS parameters in a multiparametric imaging protocol in patients who recovered from COVID-19. The 86 consecutive patients enrolled in the study had all recovered from mild or moderate COVID-19 infections; none required hospitalization. Their persistent symptoms and suspected myocarditis led to cardiac magnetic resonance imaging within 3 months of the diagnosis of the SARS-CoV-2 infection. Results: Patients with GLS less negative than −15% had significantly lower LVEF (53.6% ± 8.9 vs. 61.6% ± 4.8; <0.001) and were significantly more likely to have prolonged T1 (28.6% vs. 7.5%; p = 0.019). Left ventricular GLS correlated significantly with T1 (r = 0.303; p = 0.006) and LVEF (r = −0.732; p < 0.001). Left ventricular GLS less negative than −15% was 7.5 times more likely in patients with prolonged T1 (HR 7.62; 95% CI 1.25–46.64). The reduced basal inferolateral longitudinal strain had a significant impact on the global left ventricular longitudinal strain. ROC results suggested that a GLS of 14.5% predicted prolonged T1 relaxation time with the best sensitivity and specificity. Conclusions: CMR abnormalities, including a myocarditis pattern, are common in patients who have recovered from COVID-19. The CMR feature-tracking left ventricular GLS is related to T1 relaxation time and may serve as a novel parameter to detect global and regional myocardial injury and dysfunction in patients with suspected myocardial involvement after recovery from COVID-19.

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Cardiac abnormalities detected by echocardiography and cardiac magnetic resonance in healthcare professionals recovered from non-severe COVID-19

Cited by 3 publications

References 7 publications

A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: A multicenter cardiovascular magnetic resonance study

A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: A multicenter cardiovascular magnetic resonance study

Cardiac Magnetic Resonance Imaging of COVID-19-Associated Cardiac Sequelae: A Systematic Review

Cardiac Magnetic Resonance Relaxometry Parameters, Late Gadolinium Enhancement, and Feature-Tracking Myocardial Longitudinal Strain in Patients Recovered from COVID-19

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