Role of cardiac magnetic resonance imaging in the diagnosis and management of COVID-19 related myocarditis: Clinical and imaging considerations

Abstract

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Acute myocarditis caused by COVID-19 disease and following COVID-19 vaccination

“…According to a systematic review by Kariyanna et al ,12 the most consistent findings in suspected COVID-19-related myocarditis were cardiac biomarkers elevation; bilateral ground glass opacities on chest CT; and late gadolinium enhancement (LGE) from CMRI, both of which findings were observed in all patients in the study 12 13. Myocardial oedema was reported in more than half of these patients, and tissue characterisation through the use of LGE and T1/T2 mapping was more useful at detecting myocardial injury than assessing ventricular function according to the authors 12–15. Laboratory tests revealed leukocytosis with increased C reactive protein, and arterial blood gas analysis showed respiratory acidosis 12.…”

“…Patients with myocarditis often present with chest pain, fatigue and dyspnoea, similar to viral infections such as COVID-19 with or without myocarditis; but others, report symptoms such as myalgia, diarrhoea, nausea, vomiting and headaches 7. According to a systematic review by Kariyanna et al ,12 the most consistent findings in suspected COVID-19-related myocarditis were cardiac biomarkers elevation; bilateral ground glass opacities on chest CT; and late gadolinium enhancement (LGE) from CMRI, both of which findings were observed in all patients in the study 12 13. Myocardial oedema was reported in more than half of these patients, and tissue characterisation through the use of LGE and T1/T2 mapping was more useful at detecting myocardial injury than assessing ventricular function according to the authors 12–15.…”

“…Despite the growing understanding of COVID-19 myocardial involvement, cases of COVID-19 myocarditis are likely under-reported 13. One recent study showed the prevalence of clinically confirmed COVID-19 myocarditis across a large multinational registry to be 0.01% (256 patients), with an associated increased mortality, underscoring the importance of diagnosing patients with myocarditis early in the process 21.…”

“…The history and clinical features of myocarditis are often nonspecific, as such early recognition and aggressive intervention are key factors in reducing morbidity and mortality. Furthermore, ventricular arrhythmias and sudden cardiac death secondary to myocarditis are also a concern in COVID-19 patients 13…”

“…Subclinical myocardial involvement is also a common finding among COVID-19 patients. In fact, Li et al 23 reported 28 out of 40 COVID-19 patients with myocardial dysfunction based on reduced left ventricular 2D-global longitudinal strain, when compared with healthy controls 13 23. Twenty-four of the 40 patients exhibited elevated extracellular volume fraction in comparison with healthy controls, denoting diffuse interstitial fibrosis in a majority of these patients 13 23.…”