Cardiac magnetic resonance in recovering COVID-19 patients. Feature tracking and mapping analysis to detect persistent myocardial involvement

Abstract

Background Post-COVID-19 patients may incur myocardial involvement secondary to systemic inflammation. Our aim was to detect possible oedema/diffuse fibrosis using cardiac magnetic resonance imaging (CMR) mapping and to study myocardial deformation of the left ventricle (LV) using feature tracking (FT). Methods Prospective analysis of consecutively recruited post-COVID-19 patients undergoing CMR. T1 and T2 mapping sequences were acquired and FT analysis was performed using 2D steady-state free precession cine sequences. Statistical significance was set to p<0.05. Results Included were 57 post-COVID-19 patients and 20 healthy controls, mean age 59±15 years, men 80.7%. The most frequent risk factors were hypertension (33.3%) and dyslipidaemia (36.8%). The contact-to-CMR interval was 81±27 days. LV ejection fraction (LVEF) was 61±10%. Late gadolinium enhancement (LGE) was evident in 26.3% of patients (19.3%, non-ischaemic). T2 mapping values (suggestive of oedema) were higher in the study patients than in the controls (50.9±4.3 ms vs 48±1.9 ms, p<0.01). No between-group differences were observed for native T1 nor for circumferential strain (CS) or radial strain (RS) values (18.6±3.3% vs 19.2±2.1% (p=0.52) and 32.3±8.1% vs 33.6±7.1% (p=0.9), respectively). A sub-group analysis for the contact-to-CMR interval (<8 weeks vs ≥8 weeks) showed that FT-CS (15.6±2.2% vs 18.9±2.6%, p<0.01) and FT-RS (24.9±5.8 vs 33.5±7.2%, p<0.01) values were lower for the shorter interval. Conclusions Post-COVID-19 patients compared to heathy controls had raised T2 values (related to oedema), but similar native T1, FT-CS and FT-RS values. FT-CS and FT-RS values were lower in post-COVID-19 patients undergoing CMR after <8 weeks compared to ≥8 weeks.

Cardiac involvement in coronavirus disease 2019 assessed by cardiac magnetic resonance imaging: a meta-analysis

“…Four of the studies presented two cohorts [ 8 , 10 , 21 , 31 ]; therefore, we included a total of 33 independent cohorts. Among the 29 included studies, nine were from the USA [ 8 , 15 , 20 , 22 , 24 , 32 , 36 – 38 ], six were from China [ 10 , 11 , 16 , 18 , 21 , 30 ], three each from the UK [ 19 , 22 , 26 ] and Germany [ 7 , 23 , 28 , 35 ], two each from Italy [ 9 , 27 ] and Turkey [ 29 , 31 ], and one each from Poland [ 17 ], Norway [ 34 ], Hungary [ 33 ] and Spain [ 25 ]. The publication year was 2020 or 2021 ( Table 1 ).…”

Recent highlights on myocarditis, cardiovascular complications of COVID-19, and cardiomyopathies from the International Journal of Cardiology: Heart & Vasculature

“…A CMR study by Urmeneta Ulloa et al [25] demonstrated higher T2 mapping values in patients recovering from COVID-19 infection compared to healthy controls, consisting of residual edema, while no differences were found in T1 mapping values or feature tracking. It must be noted that while myocardial involvement, defined by troponin level increases, in patients with COVID-19 can be relatively frequent and is associated with poor prognosis [26] , [27] , true myocarditis are relatively uncommon [16] , with 2.4 cases of definite or probable myocarditis per 1000 patients hospitalized with COVID-19 [21] .…”

Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention Leadership and Endorsed by the Society for Cardiovascular Magnetic Resonance

“… 50 Figure 3 illustrates an example of an approach to standardize the results for native T1 differences based on published studies that include T1 reference values from their own center. 22 , 48 - 50 , 75 , 76 , 78 , 80 , 83 - 85 , 87 , 93 - 95 This type of meta-analysis can identify factors, such as the time of recovery because time from infection onset is a source of disease-related variability of native myocardial T1 in COVID-19 survivors.…”