Cardiac magnetic resonance findings in acute and post‐acute COVID‐19 patients with suspected myocarditis

Abstract

Introduction Cardiac injury is commonly reported in COVID‐19 patients, resulting associated to pre‐existing cardiovascular disease, disease severity, and unfavorable outcome. Aim is to report cardiac magnetic resonance (CMR) findings in patients with myocarditis‐like syndrome during the acute phase of SARS‐CoV‐2 infection (AMCovS) and post‐acute phase (cPACS). Methods Between September 2020 and January 2022, 39 consecutive patients (24 males, 58%) were referred to our department to perform a CMR for the suspicion of myocarditis related to AMCovS ( n = 17) and cPACS ( n = 22) at multimodality evaluation (clinical, laboratory, ECG, and echocardiography). CMR was performed for the assessment of volume, function, edema and fibrosis with standard sequences and mapping techniques. CMR diagnosis and the extension and amount of CMR alterations were recorded. Results Patients with suspected myocarditis in acute and post‐COVID settings were mainly men (10 (59%) and 12 (54.5%), respectively) with older age in AMCovS (58 [48–64]) compared to cPACS (38 [26–53]). Myocarditis was confirmed by CMR in most of cases: 53% of AMCovS and 50% of cPACS with negligible LGE burden (3 [IQR, 1–5] % and 2 [IQR, 1–4] %, respectively). Myocardial infarction was identified in 4/17 (24%) patients with AMCovS. Cardiomyopathies were identified in 12% (3/17) and 27% (6/22) of patients with AMCovS and cPACS, including DCM, HCM and mitral valve prolapse. Conclusions In patients with acute and post‐acute COVID‐19 related suspected myocarditis, CMR improves diagnostic accuracy characterizing ischemic and non‐ischemic injury and unraveling subclinical cardiomyopathies.

Cardiovascular magnetic resonance imaging in COVID‐19 patients: An important tool in everyday clinical practice

“…39 patients in the acute or post-acute phase of COVID-19 and found inflammatory changes in most patients. 8 However, ischemic, valvular or other cardiomyopathies could also be diagnosed on the basis of CMR. The authors mention the heterogeneous patient population as a limitation of their study.…”

“…Palmisano et al investigated cardiac changes on CMR in 39 patients in the acute or post‐acute phase of COVID‐19 and found inflammatory changes in most patients 8 . However, ischemic, valvular or other cardiomyopathies could also be diagnosed on the basis of CMR.…”

<strong></strong>An In-Depth Insight into Clinical, Cellular and Molecular Factors in COVID19-Associated Cardiovascular Ailments for Identifying Novel Disease Biomarkers, Drug Targets and Clinical Management Strategies

“…Myocardial involvement detected by CV magnetic resonance (C.M.R.) in the setting of COVID-19 infection has been reported at a prevalence of 26% to 60% in individuals with a history of hospitalization (4)(5)(6) .…”

“…The long-term CV manifestations of SARS-COV-2 (COVID-19) infection remain unknown (3)(4)(5)(6)(7). Moreover, clinical factors associated with COVID19-associated pathophysiology and underlying cellular molecular biological mechanisms are poorly understood (2)(3)(4)(5)(6) .…”

“…The long-term CV manifestations of SARS-COV-2 (COVID-19) infection remain unknown (3)(4)(5)(6)(7). Moreover, clinical factors associated with COVID19-associated pathophysiology and underlying cellular molecular biological mechanisms are poorly understood (2)(3)(4)(5)(6) . Therefore, this study aims to provide an updated account of clinical, cellular and molecular factors in cardiovascular diseases associated with COVID-19.…”