Role of Cardiac Imaging Modalities in the Evaluation of COVID-19-Related Cardiomyopathy

Abstract

Cardiac involvement has been described during the course of SARS-CoV-2 disease (COVID-19), with different manifestations. Several series have reported only increased cardiac troponin without ventricular dysfunction, others the acute development of left or right ventricular dysfunction, and others myocarditis. Ventricular dysfunction can be of varying degrees and may recover completely in some cases. Generally, conventional echocardiography is used as a first approach to evaluate cardiac dysfunction in patients with COVID-19, but, in some cases, this approach may be silent and more advanced cardiac imaging techniques, such as myocardial strain imaging or cardiac magnetic resonance, are necessary to document alterations in cardiac structure or function. In this review we sought to discuss the information provided by different cardiac imaging techniques in patients with COVID-19, both in the acute phase of the disease and after discharge from hospital, and their diagnostic and prognostic role. We also aimed at verifying whether a specific form of cardiac disease due to the SARS-CoV-2 can be identified.

Coronavirus Disease 2019, Myocardial Injury, and Myocarditis

“…CMR is the gold standard noninvasive imaging test for the assessment of cardiac chamber size and function. Most importantly, it provides accurate myocardial tissue characterization with combined MR sequences (e.g., T2-weighted imaging, late enhancement sequence, and T1/T2 mapping) to visualize myocardial edema, necrosis, and fibrosis, thus aiding in clarifying myocardial injury patterns, such as myocarditis-like abnormalities or myocardial infarction-like necrosis [4,78,79].…”

Subclinical Myocardial Injury in Patients Recovered from COVID-19 Pneumonia: Predictors and Longitudinal Assessment

“…COVID-19 infection caused by SARS-CoV-2 has been exhibiting a high morbidity and mortality secondary to the COVID-19 pandemic worldwide. In addition to the respiratory system, the cardiovascular system is also involved [1,2]. Several mechanisms could cause acute myocardial injury [3,4], such as direct cardiac damage [5], hypoxia-induced myocardial damage [6], cytokine storms [6], and macro-and micro-circulatory thrombosis [7].…”