Elevated Extracellular Volume Fraction and Reduced Global                     Longitudinal Strains in Participants Recovered from COVID-19 without Clinical                     Cardiac Findings

Xiao-hu, LI; Wang, Haitao; Zhao, Ren; Wang, Tingting; Zhu, Yinsu; Qian, Yinfeng; Liu, Bin; Yu, Yongqiang; Han, Yuchi

doi:10.1148/radiol.2021203998

Cited by 66 publications

(123 citation statements)

References 34 publications

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“…Through screening of titles and abstracts, we excluded 2670 records, leaving 197 to be assessed as full text. Of these, we finally included in this review 35 studies ( 5 , 8 , 11 , 12 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ), of which 3 were pre-prints ( 5 , 23 , 50 ), three were presented as research letters ( 21 , 43 , 51 ) and three were presented as research communications ( 22 , 31 , 44 ). The reasons for excluding 162 articles are listed in the PRISMA flow chart (see Figure 1 ) ( 52 ).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 35 studies included in this review, 15 were prospective cohort ( 8 , 12 , 22 , 29 , 30 , 31 , 34 , 35 , 40 , 41 , 42 , 44 , 45 , 47 , 50 ), 7 were case reports ( 21 , 25 , 28 , 36 , 37 , 39 , 48 ), 5 had a cross-sectional design ( 5 , 20 , 24 , 26 , 38 ), 4 were case series ( 23 , 32 , 43 , 46 ), 3 were retrospective cohort ( 11 , 27 , 49 ), and 1 was ambidirectional cohort study ( 33 ).…”

Section: Resultsmentioning

confidence: 99%

“…22 articles (63%) included patients previously hospitalized for COVID-19 (N=51117, 97.2%) ( 11 , 21 , 24 , 25 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 ), 8 studies a mixed population of discharged patients and outpatients (N= 1330, 2.5%) ( 5 , 8 , 12 , 22 , 26 , 29 , 47 , 50 ) among which one included healthcare workers ( 5 ), 5 included only outpatients (N=122; 0.3%) ( 20 , 23 , 27 , 28 , 30 ), among which 4 included solely athletes ( 20 , 23 , 27 , 30 ).…”

Section: Resultsmentioning

confidence: 99%

“…Using the WHO scale for COVID-19 severity ( 15 ), we divided the latter population into severity categories and then combined them with other studies with pre-specified groups. Studies included participants with a majority of asymptomatic-mild (13/35 studies; N=1359 participants) ( 5 , 12 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 50 ), moderate-critical (21/35 studies; N=51234 participants) ( 8 , 11 , 25 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 ) and one remaining study (N=16 participants) with no clear demarcation ( 46 ).Most studies were from Europe (n=19/35; 54.3%), followed by Asia (10/35; 28.6%), North America (5/35; 14.3%), and Africa (1/35; 2.9%).…”

Section: Resultsmentioning

confidence: 99%

“…For cardiac sequelae assessment, utilized methods included CMR (n=16 studies, 45.7%) ( 5 , 11 , 12 , 20 , 23 , 25 , 27 , 28 , 29 , 30 , 34 , 35 , 37 , 39 , 40 , 46 ), echocardiography (n=14, 40%) ( 20 , 21 , 22 , 23 , 25 , 28 , 30 , 32 , 36 , 38 , 44 , 45 , 47 , 48 ), electrocardiography (ECG) (n=16, 45.3%) ( 5 , 20 , 21 , 22 , 23 , 25 , 27 , 28 , 30 , 32 , 34 , 36 , 37 , 38 , 39 , 48 ), troponin (n=17, 48.5%) ( 5 , 11 , 20 , 23 , 27 , 28 , 29 , 30 , 32 , 34 , 35 , 36 , 37 , 39 , 44 , 45 , 46 ), questionnaire (n=9, 25.7%) ( 8 , 12 , 24...…”

Section: Resultsmentioning

confidence: 99%

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Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

Ramadan

Bertolino

Zampino

et al. 2021

Clinical Microbiology and Infection

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Background Coronavirus disease 2019 (COVID-19) has been implicated in a wide spectrum of cardiac manifestations following the acute phase of the disease. Objectives To assess the range of cardiac sequelae after COVID-19 recovery. Data sources PubMed, Embase, Scopus (inception through 17 February 2021), and Google scholar (2019 through 17 February 2021). Study eligibility criteria Prospective and retrospective studies, case reports and case series. Participants Adult patients assessed for cardiac manifestations after COVID-19 recovery. Exposure Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosed by polymerase chain reaction (PCR). Methods Systematic review. Results Thirty-five studies (fifteen prospective cohort, seven case reports, five cross-sectional, four case series, three retrospective cohort and one ambidirectional cohort) evaluating cardiac sequelae in 52609 patients were included. Twenty-nine studies utilized objective cardiac assessments, mostly cardiac magnetic resonance imaging (CMR) in sixteen studies, echocardiography in fifteen, electrocardiography (ECG) in sixteen and cardiac biomarkers in eighteen. Most studies had a fair risk of bias. The median time from diagnosis/recovery to cardiac assessment was 48 days (1-180). Common short-term cardiac abnormalities (<3 months) included increased T1 (proportion: 30%), T2 (16%), pericardial effusion (15%) and late gadolinium enhancement (LGE, 11%) on CMR, with symptoms such as chest pain (25%) and dyspnea (36%). In the medium term (3-6 months), common changes included reduced left ventricular global longitudinal strain (30%) and LGE (10%) on CMR, diastolic dysfunction (40%) on echocardiography and elevated NT-proBNP (18%). In addition, COVID-19 survivors had higher risk (RR = 3; 95% CI: 2.7-3.2) of developing heart failure, arrythmias and myocardial infarction. Conclusions COVID-19 appears to be associated with persistent/de novo cardiac injury after recovery, particularly subclinical myocardial injury in the earlier phase and diastolic dysfunction later. Larger well-designed and controlled studies with baseline assessments are needed to better measure the extent of cardiac injury and its clinical impact.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

Ramadan

Bertolino

Zampino

et al. 2021

Clinical Microbiology and Infection

View full text Add to dashboard Cite

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Combined Cardiac Fluorodeoxyglucose–Positron Emission Tomography/Magnetic Resonance Imaging Assessment of Myocardial Injury in Patients Who Recently Recovered From COVID-19

et al. 2022

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IMPORTANCEAlthough myocardial injury can occur with acute COVID-19, there is limited understanding of changes with myocardial metabolism in recovered patients.OBJECTIVE To examine myocardial metabolic changes early after recovery from COVID-19 using fluorodeoxyglucose-positron emission tomography (PET) and associate these changes to abnormalities in cardiac magnetic resonance imaging (MRI)-based function and tissue characterization measures and inflammatory blood markers. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study took place at a single-center tertiary referral hospital system. A volunteer sample of adult patients within 3 months of a diagnosis of COVID-19 who responded to a mail invitation were recruited for cardiac PET/MRI and blood biomarker evaluation between November 2020 and June 2021.EXPOSURES Myocardial inflammation as determined by focal fluorodeoxyglucose (FDG) uptake on PET.MAIN OUTCOMES AND MEASURES Demographic characteristics, cardiac and inflammatory blood markers, and fasting combined cardiac 18 F-FDG PET/MRI imaging were obtained. All patients with focal FDG uptake at baseline returned for repeated PET/MRI and blood marker assessment 2 months later. RESULTSOf 47 included patients, 24 (51%) were female, and the mean (SD) age was 43 (13) years. The mean (SD) interval between COVID-19 diagnosis and PET/MRI was 67 (16) days. Most patients recovered at home during the acute infection (40 [85%]). Eight patients (17%) had focal FDG uptake on PET consistent with myocardial inflammation. Compared with those without FDG uptake, patients with focal FDG uptake had higher regional T2, T1, and extracellular volume (colocalizing with focal FDG uptake), higher prevalence of late gadolinium enhancement (6 of 8 [75%] vs 9 of 39 [23%], P = .009), lower left ventricular ejection fraction (mean [SD], 55% [4%] vs 62% [5%], P < .001), worse global longitudinal and circumferential strain (mean [SD], −16% [2%] vs −17% [2%], P = .02 and −18% [2%] vs −20% [2%], P = .047, respectively), and higher systemic inflammatory blood markers including interleukin 6, interleukin 8, and high-sensitivity C-reactive protein. Among patients with focal FDG uptake, PET/MRI, and inflammatory blood markers resolved or improved at follow-up performed a mean (SD) of 52 (17) days after baseline PET/MRI. CONCLUSIONS AND RELEVANCEIn this study of patients recently recovered from COVID-19, myocardial inflammation was identified on PET in a small proportion of patients, was associated with cardiac MRI abnormalities and elevated inflammatory blood markers at baseline, and improved at follow-up.

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Cardiac involvement in patients recovering from Delta Variant of COVID‐19: a prospective multi‐parametric MRI study

et al. 2022

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AimsThe cardiac injury and sequelae of Delta Variant of coronavirus disease 2019 remain unknown. This study aimed to evaluate the presence of cardiac involvement in patients recovering from Delta Variant of COVID-19 based on multiparametric cardiac magnetic resonance imaging (MRI). Methods and resultsWe prospectively assessed patients recovering from Delta Variant of COVID-19 using multi-parametric cardiac magnetic resonance imaging (MRI) between June 2021 and July 2021. Comparison was made with 25 healthy controls. Forty-four patients (median age 51 years, 28 women) recovering from Delta Variant were recruited and had a median time of 35 days between diagnosis and cardiac MRI. There were no patients with chest pain (0/44, 0%) and high sensitivity cardiac troponin T troponin elevation (median levels 2.20 pg/mL, IQR levels 0.85-4.40 pg/mL). Regarding the cardiac imaging findings, a total of 14 (32%) patients presented cardiac tissue feature abnormalities, and a total of 9 (20%) patients had a myocarditis-like injury based on cardiac MRI 2018 Lake Louise criteria. When we further assessed the T1 and T2 mapping values for of patients' individual, abnormal raised global native T1, T2, and extracellular volume were seen in 6 (14%), 6 (14%), and 4 (9%) patients, respectively. Comparing with controls, the patients had lower LV global longitudinal strain and (À22.2 ± 2.8% vs. À24.6 ± 2.0%, P < 0.001) and global circumferential strain (À20.7 ± 6.8% vs. À24.3 ± 2.9%, P = 0.014), but higher global native T1 (1318.8 ± 55.5 ms vs. 1282.9 ± 38.1 ms, P = 0.006). Four (9%) patients presented myocardial late gadolinium enhancement with subepicardial pattern mostly common seen, and two (5%) patients presented pericardial enhancement. Conclusions The cardiac MRI could detect subclinical functional and myocardial tissue characteristic abnormalities in individuals who were recovering from Delta Variant without cardiac-related clinical findings. The native T1 mapping and strain imaging may be a sensitive tool for the noninvasive detection of a subset of patients who are at risk for cardiac sequelae and more prone to myocardial damage in survivors with Delta Variant.

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Elevated Extracellular Volume Fraction and Reduced Global Longitudinal Strains in Participants Recovered from COVID-19 without Clinical Cardiac Findings

Cited by 66 publications

References 34 publications

Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

Combined Cardiac Fluorodeoxyglucose–Positron Emission Tomography/Magnetic Resonance Imaging Assessment of Myocardial Injury in Patients Who Recently Recovered From COVID-19

Cardiac involvement in patients recovering from Delta Variant of COVID‐19: a prospective multi‐parametric MRI study

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