Risk stratification of cardiac sequelae detected using cardiac magnetic resonance in late convalescence at the six-month follow-up of recovered COVID-19 patients

Abstract

Risk stratification of cardiac sequelae detected using cardiac magnetic resonance in late convalescence at the six-month follow-up of recovered COVID-19 patients Dear editor , Follow-up studies in COVID-19 survivors have found persistent symptoms (fatigue, dyspnea, muscle pain et, al.), impaired pulmonary function, abnormal chest CT images in COVID-19 survivors even after 110 days and 6 month of follow-up. 1 , 2 Several studies also have reported that cardiac involvement, including myocardial edema, fibrosis, and cardiac dysfunction, detected by using multi-parameter cardiac magnetic resonance (CMR) techniques were identified in recovered COVID-19 patients during early convalescence. [3][4][5][6][7][8] However, whether COVID-19 has a continuous influence on the cardiovascular system in late convalescence is unknown. Therefore, we used traditional CMR sequences to evaluate cardiac abnormalities in late convalescence comprehensively, including cardiac function, myocardial deformation, and myocardial tissue characteristics, and explore its related risk factors.34 recovered COVID-19 patients at Chengdu Public Health Clinical Medical Centre were prospectively enrolled and followed-up from Jan 1 to Oct 20, 2020. Diagnosis and discharging of COVID-19 patients were based on guidelines of the Chinese Center for Disease Control and Prevention. 9 Six months after discharging from hospital, gadolinium enhanced CMR scan (1.5T, Signa HDxt; GE Medical systems, USA) was performed and 20 healthy controls were enrolled too. All the patients and healthy controls signed informed consent and the institutional ethics board of our institutes approved this study (No. 2020.43). Electrocardiography, echocardiography, laboratory test, and clinical characters at admission were collected. Cardiac abnormalities were defined as a combination of elevated myocardial enzyme and injury marker, abnormal echocardiographic and electrocardiographic results. Patients was divided into two subgroups, subgroup with/without cardiac abnormalities at admission.Biventricular function, myocardial deformation, myocardial edema and fibrosis were evaluated with postprocessing software Cvi42 (Circle Cardiovascular Imaging, Calgary, Canada). Cardiac dysfunction was a combination of left ventricular ejection fraction (LVEF) less than 50%, right ventricular ejection fraction (RVEF) less than 45%, and LV deformation dysfunction. CMR abnormalities was a combination of myocardial edema, fibrosis, and cardiac dysfunction.At admission, 23 (67.65%) patients had cardiac abnormalities, 7 (20.59%) patients had elevated myocardial enzyme, 2 (5.88%) patients had elevated myocardial injury maker, 3 (8.82%) and 20 (58.82%) patients reported abnormal echocardiographic and electrocardiographic results. None of these 34 patients reported cardiovascular-related symptoms or signs during follow-up.

Cardiac Magnetic Resonance Imaging Findings in 2954 COVID‐19 Adult Survivors: A Comprehensive Systematic Review

“…Patients were consecutively recruited in 15 studies (six case series and nine cohort studies), regardless of cardiac symptoms at the acute phase or follow-up time. 8,10,11,[13][14][15]23,[25][26][27][28][29]34 The mean/median age of participants ranged from 19 to 68 years, with a male predominance in most studies. Median/ mean time from diagnosis/discharge to the cardiac imaging assessment varied across the studies, with a minimum of 15 days and a maximum of 180 days.…”

From heart to muscle: pathophysiological mechanisms underlying long-term physical sequelae from SARS-CoV-2 infection

“…Consistent with these findings, cardiac MRI abnormalities and diastolic dysfunction were documented in 30%–60% of previously hospitalized and outpatients 2–3 mo since hospital discharge ( 37 , 38 ). Importantly in terms of trajectory post-COVID-19, signs of cardiac injury were present in between ∼30% ( 39 ) and 65% of patients ∼6 mo post-hospitalization, with greater persistence of tissue damage in those who experienced a more severe acute form of the disease ( 40 ).…”

Riesgo cardiovascular en pacientes recuperados de COVID-19 a corto y mediano plazo: ¿qué concluye la evidencia actual?

“…La miocarditis pos-COVID-19 empezó a ser llamativa a mediados del 2020, con el surgimiento de varios reportes en la literatura; por ejemplo, en un estudio de 29 pacientes hospitalizados por COVID-19 con troponina elevada de causa desconocida, el 45 % tenía realce tardío de gadolinio en un patrón no isquémico "similar a miocarditis" en la resonancia magnética cardíaca aproximadamente 27 días después del alta, pero con ecocardiograma que mostraba fracción de eyección del ventrículo izquierdo normal, sin anomalías en el movimiento de las paredes ventriculares, con lo cual se descartaba la insuficiencia cardiaca (46,48) . Otros estudios con resonancia magnética han informado, en pacientes 6 meses después del alta, la persistencia de edema miocárdico y fibrosis; sin embargo, ninguno de los pacientes informó síntomas relacionados con el sistema cardiovascular durante el seguimiento (49,50) .…”