Cardiac Magnetic Resonance Findings in Patients Recovered from COVID-19 Pneumonia and Presenting with Persistent Cardiac Symptoms: The TRICITY-CMR Trial

Abstract

The prevalence and clinical consequences of coronavirus disease 2019 (COVID-19)-related non-ischemic cardiac injury are under investigation. The main purpose of this study was to determine the occurrence of non-ischemic cardiac injury using cardiac magnetic resonance (CMR) imaging in patients with persistent cardiac symptoms following recovery from COVID-19 pneumonia. We conducted a single-center, cross-sectional study. Between January 2021 and May 2021, we enrolled 121 patients with a recent COVID-19 infection and persistent cardiac symptoms. Study participants were divided into those who required hospitalization during the acute phase of SARS-CoV-2 infection (n = 58; 47.9%) and those non-hospitalized (n = 63; 52.1%). Non-ischemic cardiac injury (defined as the presence of late gadolinium enhancement (LGE) lesion and/or active myocarditis in CMR) was detected in over half of post-COVID-19 patients (n = 64; 52.9%). LGE lesions were present in 63 (52.1%) and active myocarditis in 10 (8.3%) post-COVID-19 study participants. The majority of LGE lesions were located in the left ventricle at inferior and inferolateral segments at the base. There were no significant differences in the occurrence of LGE lesions (35 (60.3%) vs. 28 (44.4%); p = 0.117) or active myocarditis (6 (10.3%) vs. 4 (6.3%); p = 0.517) between hospitalized and non-hospitalized post-COVID-19 patients. However, CMR imaging revealed lower right ventricular ejection fraction (RVEF; 49.5 (44; 54) vs. 53 (50; 58) %; p = 0.001) and more frequent presence of reduced RVEF (60.3% vs. 33.3%; p = 0.005) in the former subgroup. In conclusion, more than half of our patients presenting with cardiac symptoms after a recent recovery from COVID-19 pneumonia had CMR imaging abnormalities indicating non-ischemic cardiac injury. The most common finding was LGE, while active myocarditis was detected in the minority of patients. CMR imaging abnormalities were observed both in previously hospitalized and non-hospitalized post-COVID-19 patients. Further research is needed to determine the long-term cardiovascular consequences of COVID-19 infection and the optimal management of patients with suspected post-COVID-19 non-ischemic cardiac injury.

Role of Cardiovascular Magnetic Resonance Imaging in Early Detection of Myocarditis in Patients Recovered from COVID-19

“…But no statistically significant difference regarding RVEF. It was in concordance with Wojtowicz et al [14] who reported statistically significant difference between the two groups of patients with and without Non-Ischemic Cardiac Injury regarding LVEF (57% vs 61%, P<.001), but no statistically significant difference regarding LVEDV and RVEF.…”

“…Our study showed statistically significant difference between both groups regarding level of Tn I as we found 11 (47%) patients with elevated Tn I in myocarditis group versus only 1 (3.7%) patient in the normal group. This was in line with Wojtowicz et al [14] who reported statistically significant difference between the two groups of patients with and without non-ischemic cardiac injury using CMR regarding Tn I level. In the current study, there was a statistically significant difference between both groups regarding ECG abnormality as we found 12 (52%) patients with ECG abnormality in myocarditis group versus only 1 (3.7%) patient in the normal group.…”

Transformative Effect of COVID-19 Pandemic on Magnetic Resonance Imaging Services in One Tertiary Cardiovascular Center

“…We found increases in the rates of diagnostic procedures and detected pathological changes in the cardiovascular system during the third year of the COVID-19 pandemic, which also may suggest a chronic course of this disease. Prospects for the wider use of MRI in diagnosing not only chronic cardiac but also chronic lung complications of COVID-19 require further exploration, considering that pilot data show MRI to be an accurate and informative imaging modality in this regard [ 12 , 32 , 33 , 34 , 35 , 36 ]. The CMR may be considered the most useful noninvasive test to detect myocarditis and can give detailed information in terms of myocardial structure and function [ 37 , 38 , 39 ].…”

Epidemiology Aspects of Magnetic Resonance Imaging in the Context of COVID-19 Pandemic

“…Interestingly, we found the increases in the rates of diagnostic procedures and detected pathological changes of cardiovascular system during the third year of COVID-19 pandemic, which also may suggest chronic course of this disease. Prospects for wider use of MRI in diagnosing not only chronic cardiac, but also chronic lung complications of COVID-19 require further exploration considering that pilot data show MRI an accurate and informative imaging modality in this regard [12,[31][32][33][34][35].…”