Cardiac magnetic resonance imaging in patients with history of COVID-19

Abstract

Background. Myocarditis is among the most common complications of coronavirus infection (COVID-19).
 Aim. The aim of the study was to find the differences in the patterns of myocardial injury in patients who had COVID-19 and patients during pre-pandemic period according to contrast-enhanced cardiac magnetic resonance imaging (CE-CMR).
 Materials and Methods. The study included a total of 47 retrospective patients who underwent CE-CMR to rule out acute myocarditis. Group 1 comprised 34 patients with history of COVID-19 confirmed by PCR test (nasal and/or throat swabs). Group 2 included 13 individuals who underwent CE-CMR in 2017 before onset of COVID-19 pandemic. All patients enrolled in the study had clinical manifestation of cardiac injury without signs of coronary artery disease as an underlying cause of condition.
 Results. Mean time from onset of heart symptoms to administration of CE-CMR was 166 days. In in group 1, a decrease in exercise tolerance was observed in 77% of patients, and 14 (42%), 30 (88%), and 28 (85%) of patients complained of chest pain, shortness of breath, and heart palpitations, respectively. In group 2, four patients (30%) had dyspnea; nine patients (69%) complained of chest pain; and six patients (46%) had heart palpitations and/or feeling of arrhythmia. Myocardial injury in patients of group 1 was more generalized. The third of them had preserved increased pulmonary vascularity and pleural effusion. Men in group 1 had significantly lower left ventricular ejection fraction, lower values of global longitudinal deformation, and higher values of left atrial function compared with the corresponding parameters in women. Differences in women were found only in the number of the affected segments in the left ventricular myocardium.
 Conclusion. SARS-CoV-2 virus caused extended myocardial injury with involvement of significant number of myocardial segments. Men had more frequent postinflammatory complications in the form of abnormal function of the left ventricle and left atrium. Obtained results require continuous efforts for further assessment of long-term consequences of previous COVID-19 to the cardiovascular system. In this regard, CE-CMR may represent a sensitive imaging tool for the assessment of cardiac injury severity.