COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel

Skulstad, Helge; Cosyns, Bernard; Popescu, Bogdan A; Galderisi, Maurizio; Salvo, Giovanni Di; Donal, Erwan; Petersen, Steffen E.; Gimelli, Alessia; Haugaa, Kristina H.; Muraru, Denisa; Almeida, Ana G.; Schulz‐Menger, Jeanette; Dweck, Marc R; Pontone, Gianluca; Sade, Leyla Elif; Gerber, Bernhard; Maurovich-Horvat, Pál; Bharucha, Tara; Cameli, Matteo; Magné, Julien; Westwood, Mark; Maurer, Gerald; Edvardsen, Thor

doi:10.1093/ehjci/jeaa072

Cited by 267 publications

(371 citation statements)

References 14 publications

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“…Because CMR is the most comprehensive imaging modality to elucidate underlying pathophysiology, some guidelines have recommended inpatient CMR for treatment disposition. 7 However, increased risk of exposure of healthcare workers should strongly be considered, and CMR should be deferred in the acute setting if management by echocardiographic assessment is suffi cient for acute therapeutic guidance. Alternatively, CMR during the convalescent phase may elucidate important mechanistic insights regarding the pathophysiology and extent of myocardial injury, which can dictate therapeutic strategies and determine the likelihood of left and right ventricular recovery vs conversion into chronic heart disease.…”

Section: ■ Acute Myocardial Injurymentioning

confidence: 99%

“…Patients with stable symptoms and low or intermediate risk should have imaging deferred to a later date and be treated medically unless their condition becomes progressive and clinically unstable. 6,7 Invasive coronary angiography and revascularization should be considered only in the scenario of ST-elevation myocardial infarction; however, thrombolysis is a reasonable alternative in SARS-CoV-2 infection. If invasive coronary angiography is warranted, then left ventriculography may eliminate the need for TTE 6 in the acute setting.…”

Section: ■ Acute Myocardial Injurymentioning

confidence: 99%

“…Clinicians now must also consider the impact of potential exposure of healthcare workers, the concern for medical devices acting as fomites and causing nosocomial spread, and the feasibility of treatment options when determining diagnostic strategies for COVID-19 patients. 6,7 ■ GENERAL RECOMMENDATIONS It is critically important to provide basic cardiorespiratory support to COVID-19 patients based on physical assessment with a thorough evaluation of risks and benefi ts before considering additional testing. Therefore, the following questions should be considered when ordering cardiac imaging: 1.…”

mentioning

confidence: 99%

“…TTE with off-axis views, use of contrast agents, or CCT with contrast for left atrial appendage thrombus assessment may occasionally serve as adequate alternatives. 6,7 Infection-control precautions related to cardiac imaging should be followed with regard to equipment, personnel, protection, and location, which are outside the scope of this article. 6,7 Cardiac imaging should be delayed until outpatient follow-up of COVID-19 patients with suspected subacute clinical myocardial involvement.…”

mentioning

confidence: 99%

“…6,7 Infection-control precautions related to cardiac imaging should be followed with regard to equipment, personnel, protection, and location, which are outside the scope of this article. 6,7 Cardiac imaging should be delayed until outpatient follow-up of COVID-19 patients with suspected subacute clinical myocardial involvement. However, given the uncertainty regarding the duration of viral shedding, the development of strategic work-fl ow for outpatient cardiac imaging in convalescent COVID-19 patients should be considered and developed.…”

mentioning

confidence: 99%

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The role of cardiac imaging in hospitalized COVID-19–positive patients

Wang

Tang

Flamm

et al. 2020

CCJM

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Section: ■ Acute Myocardial Injurymentioning

confidence: 99%

Section: ■ Acute Myocardial Injurymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The role of cardiac imaging in hospitalized COVID-19–positive patients

Wang

Tang

Flamm

et al. 2020

CCJM

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Clinical and economic outcomes of pharmacological stress tests in patients with a history of COVID‐19

Skali

Walker

Jiang

et al. 2023

Clinical Cardiology

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Background Despite millions of COVID‐19 cases in the United States, it remains unknown whether a history of COVID‐19 infection impacts the safety of pharmacologic myocardial perfusion imaging stress testing (pharmacologic MPI). Hypothesis The aim of this study was to assess if a prior COVID‐19 infection was associated with a higher risk of complications during and following pharmacologic MPI testing. Methods This retrospective cohort analysis included 179 803 adults (≥18 years) from the PharMetrics® Plus claims database who underwent pharmacologic MPI between March 1, 2020 and February 28, 2021. Patients with a history of COVID‐19 infection (COVID‐19 group) were compared with propensity‐score matched no‐COVID‐19 history group for reversal agent use, 30‐day resource use, and post‐MPI cardiac events/procedures. Results The most commonly used stress agent was regadenoson (91.7%). The COVID‐19 group (n = 6372; 3.5%) had slightly higher: reversal agent use (difference 1.13% [95% confidence interval [CI]: 0.33, 1.92]), all‐cause costs (difference USD $128 [95% CI: $73–$181]), and office visits (81.5% vs. 77.0%) than the no‐COVID‐19 group. Prior COVID‐19 infection did not appear to impact subsequent cardiac events/procedures. Conclusions COVID‐19 history was associated with slightly higher reversal agent use, all‐cause costs, and office visits after pharmacologic MPI; however, the differences were not clinically meaningful. Concerns for use of stress agents in patients with prior COVID‐19 do not appear to be warranted.

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Late phase of COVID‐19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice

et al. 2021

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Cardiovascular (CV) engagement in coronavirus disease 2019 (COVID‐19) is a huge determinant of prognosis during the acute phase of the disease. However, little is known about the potential chronic implications of the late phase of COVID‐19 and about the appropriate approach to these patients. Heart failure, type 1 and type 2 myocardial infarction, arrhythmias, myocarditis, pulmonary fibrosis, and thrombosis have been shown to be related to severe acute respiratory syndrome coronavirus 2 infection, and a ‘long COVID‐19’ illness has been recognized with fatigue, chest pain, and dyspnoea among the most frequent symptoms reported after discharge from hospital. This paper focuses on some open questions that cardiologists are going to face during the next months in a general cardiology outpatient clinic, in particular how to evaluate a ‘post‐COVID’ patient during follow‐up of CV complications of the acute phase and how to manage new CV symptoms that could be the consequence, at least in part, of heart/vessels and/or lung involvement of the previous virus infection. Present symptoms and signs, history of previous CV disease (both preceding COVID‐19 and occurring during viral infection), and specific laboratory and imaging measurements during the acute phase may be of interest in focusing on how to approach the clinical evaluation of a post‐COVID patient and how to integrate in our standard of care the new information on COVID‐19, possibly in a multidisciplinary view. Dealing with the increased COVID‐associated CV risk burden and becoming acquainted with potential new e‐cardiology approaches aimed at integrating the cardiology practice are relevant new challenges brought by severe acute respiratory syndrome coronavirus 2 infection and its sequelae.

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COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel

Cited by 267 publications

References 14 publications

The role of cardiac imaging in hospitalized COVID-19–positive patients

The role of cardiac imaging in hospitalized COVID-19–positive patients

Clinical and economic outcomes of pharmacological stress tests in patients with a history of COVID‐19

Late phase of COVID‐19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice

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