COVID-19 myocarditis cardiac magnetic resonance findings in symptomatic patients

Abstract

Background Coronavirus disease 2019 (COVID-19) may cause myocardial damage. Purpose To evaluate the short-term and medium-term results, as well as the imaging features of COVID-19 cardiac involvement, using cardiac magnetic resonance (CMR). Material and Methods In this study, laboratory and CMR findings of 15 patients with COVID-19 between May 2020 and May 2021 were evaluated retrospectively. Late gadolinium enhancement (LGE) imaging was evaluated for myocarditis. Cardiac functions were quantitatively evaluated and compared to the control patient group. High-sensitivity cardiac troponin I (Hs-cTnI), C-reactive protein (CRP) exchange, and LGE were compared. Results Fifteen patients (7 women; mean age = 38 years) were evaluated. Six patients were treated at home, while nine patients were treated in the hospital. The patients were given remdesivir and hydroxychloroquine treatment. LGE was detected in 2 (33%) patients treated at home and 5 (55.5%) patients treated in the hospital. In hospitalized patients, levels of Hs-cTnI (mean = 7.8 pg/mL) and CRP (mean = 32.3 mg/L) were elevated. A high correlation was observed between the increase in Hs-cTnI value and LGE ( r = 0.63; P < 0.001). A low correlation was observed between an increase in CRP and LGE ( r = 033; P < 0.001). There was no statistically significant difference in ventricular functions between the COVID-19 and control groups ( P < 0.001). Conclusion CMR abnormalities were found in a high percentage (46%) of patients with COVID-19. Myocardial abnormalities in patients with COVID-19 can be detected by CMR. For COVID-19 myocarditis, no specific diagnostic CMR imaging feature was observed.

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 ).…”

“…Finally, 10.462 patients with COVID-19, including 1010 non-athletes and 9.452 athletes, and 746 controls were included in our analysis. A 1.5 T MR scanner was used in 15 studies [ 8 , 9 , 11 , 15 , 17 , 22 – 26 , 28 , 29 , 33 – 35 ] and a 3.0 T MR scanner was used in six studies [ 7 , 10 , 16 , 18 , 21 , 30 ], Both 1.5 T and 3.0 T scanners were used in one study [ 20 ] and data regarding MR scanners were not provided in seven studies [ 19 , 27 , 31 , 32 , 36 – 38 ]. As the myocardial native T1 time substantially differs between different magnetic field strengths and sequences [ 39 ], we investigated the number patients with abnormal T1 time, rather than those with absolute value of native T1 time, among the nine studies presenting the prevalence of patients with abnormal native T1 times [ 7 – 9 , 11 , 17 , 22 , 26 , 27 , 32 ].…”

CMR Findings in COVID-19 Recovered Patients: A Review on Parametric Mapping, Feature-Tracking, and LGE

“…We identified 648 records, from which 60 were retrieved for further analysis. Following the eligibility assessment, nineteen studies were finally included in this review [4,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]; their characteristics are shown in Table 1 (Ref. [4,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]).…”

“…Cohort description T2 (ms) 1 Visible edema (N (%)) 1 Pericardial effusion (N (%)) 1 Pericardial enhancement (N (%)) 1 Field strength = 1.5 T Kotecha et al [28] LGE data from the selected reports are summarized in Table 4 (Ref [4,[24][25][26][27][28]30,31,33,[35][36][37][38][39][40][41]). Kotecha et al [28] found significant positive LGE in 49% of the patients who recovered from COVID-19, Thornton et al [37] reported it in 56%, and Puntmann et al [35] found 32% (myocardial) and 22% (pericardial).…”

“…Kotecha et al [28] found significant positive LGE in 49% of the patients who recovered from COVID-19, Thornton et al [37] reported it in 56%, and Puntmann et al [35] found 32% (myocardial) and 22% (pericardial). An author reported LGE with non-specific distribution and appearance [24], while others found subepicardial, subendocardial, and intramyocardial [25,28,41], myocarditis-like [4,26], and nonischemic [33,38] patterns. Generally, LGE patterns can help differentiate between ischemic and non-ischemic myocardial injury.…”