Spectrum of lesions visualized in cardiac magnetic resonance imaging in COVID-19-related myocarditis: Findings from a pilot study of the TRICITY-CMR trial

Wojtowicz, Dagmara; Dorniak, Karolina; Ławrynowicz, Marzena; Rejszel-Baranowska, Joanna; Fijałkowska, Jadwiga; Kulawiak-Gałąska, Dorota; Szurowska, Edyta; Koziński, Marek

doi:10.5603/cj.a2021.0139

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…The TRICITY-CMR trial was designed as a single-center, cross-sectional study. The results of its pilot study were previously published in a research letter [ 12 ]. Here we report the detailed study methodology together with the final results of the overall study population.…”

Section: Methodsmentioning

confidence: 99%

Cardiac Magnetic Resonance Findings in Patients Recovered from COVID-19 Pneumonia and Presenting with Persistent Cardiac Symptoms: The TRICITY-CMR Trial

Wojtowicz

Dorniak

Ławrynowicz

et al. 2022

Biology

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The prevalence and clinical consequences of coronavirus disease 2019 (COVID-19)-related non-ischemic cardiac injury are under investigation. The main purpose of this study was to determine the occurrence of non-ischemic cardiac injury using cardiac magnetic resonance (CMR) imaging in patients with persistent cardiac symptoms following recovery from COVID-19 pneumonia. We conducted a single-center, cross-sectional study. Between January 2021 and May 2021, we enrolled 121 patients with a recent COVID-19 infection and persistent cardiac symptoms. Study participants were divided into those who required hospitalization during the acute phase of SARS-CoV-2 infection (n = 58; 47.9%) and those non-hospitalized (n = 63; 52.1%). Non-ischemic cardiac injury (defined as the presence of late gadolinium enhancement (LGE) lesion and/or active myocarditis in CMR) was detected in over half of post-COVID-19 patients (n = 64; 52.9%). LGE lesions were present in 63 (52.1%) and active myocarditis in 10 (8.3%) post-COVID-19 study participants. The majority of LGE lesions were located in the left ventricle at inferior and inferolateral segments at the base. There were no significant differences in the occurrence of LGE lesions (35 (60.3%) vs. 28 (44.4%); p = 0.117) or active myocarditis (6 (10.3%) vs. 4 (6.3%); p = 0.517) between hospitalized and non-hospitalized post-COVID-19 patients. However, CMR imaging revealed lower right ventricular ejection fraction (RVEF; 49.5 (44; 54) vs. 53 (50; 58) %; p = 0.001) and more frequent presence of reduced RVEF (60.3% vs. 33.3%; p = 0.005) in the former subgroup. In conclusion, more than half of our patients presenting with cardiac symptoms after a recent recovery from COVID-19 pneumonia had CMR imaging abnormalities indicating non-ischemic cardiac injury. The most common finding was LGE, while active myocarditis was detected in the minority of patients. CMR imaging abnormalities were observed both in previously hospitalized and non-hospitalized post-COVID-19 patients. Further research is needed to determine the long-term cardiovascular consequences of COVID-19 infection and the optimal management of patients with suspected post-COVID-19 non-ischemic cardiac injury.

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Section: Methodsmentioning

confidence: 99%

Cardiac Magnetic Resonance Findings in Patients Recovered from COVID-19 Pneumonia and Presenting with Persistent Cardiac Symptoms: The TRICITY-CMR Trial

Wojtowicz

Dorniak

Ławrynowicz

et al. 2022

Biology

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“…It is also important to recognize that LGE signal intensity varies in relation to magnetic field strength and that prevalence of LGE has been shown to vary in relation to signal intensity thresholds 73,74 concepts of substantial importance given that differential diagnostic thresholds have been used to define prevalence of LGE in COVID-focused research (Table S1). [48][49][50][51][52]61,72,[75][76][77][78][79][80][81][82][83][84][85][86][87] Last, it should be noted that some groups have reported that LGE can occur in high endurance athletes in the absence of COVID-19 infection, 64,88,89 raising the possibility that observed patterns might be a consequence of increased LV wall stress, altered myocardial perfusion gradients, or hemodynamic sequelae of athletic competition itself. While the underlying mechanism for this association is uncertain, it is known that the finding of LGE itself does not provide temporal information-highlighting the importance of adjunctive CMR approaches to elucidate time course of myocardial injury.…”

Section: Technical Considerations Regarding Heterogeneity In Lge and ...mentioning

confidence: 99%

Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention Leadership and Endorsed by the Society for Cardiovascular Magnetic Resonance

Ruberg

Baggish

Hays

et al. 2023

Circ: Cardiovascular Imaging

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The global pandemic of COVID-19 caused by infection with SARS-CoV-2 is now entering its fourth year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. Although pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play) following resolution of infection. A variety of different testing combinations that leverage ECG, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance imaging have been proposed and implemented to mitigate risk. Cardiovascular magnetic resonance in particular affords high sensitivity for myocarditis but has been employed and interpreted nonuniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to return to play. This consensus document synthesizes available evidence to contextualize the appropriate utilization of cardiovascular magnetic resonance in the return to play assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.

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“…We identified 648 records, from which 60 were retrieved for further analysis. Following the eligibility assessment, nineteen studies were finally included in this review [4,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]; their characteristics are shown in Table 1 (Ref. [4,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]).…”

Section: Cmr Findings In Recovered Covid-19 Patientsmentioning

confidence: 99%

“…Cohort description T2 (ms) 1 Visible edema (N (%)) 1 Pericardial effusion (N (%)) 1 Pericardial enhancement (N (%)) 1 Field strength = 1.5 T Kotecha et al [28] LGE data from the selected reports are summarized in Table 4 (Ref [4,[24][25][26][27][28]30,31,33,[35][36][37][38][39][40][41]). Kotecha et al [28] found significant positive LGE in 49% of the patients who recovered from COVID-19, Thornton et al [37] reported it in 56%, and Puntmann et al [35] found 32% (myocardial) and 22% (pericardial).…”

Section: Authormentioning

confidence: 99%

“…The most frequently involved walls were the inferior and inferior-lateral of the basal segment. Wojtowicz et al[40], 2021 (L) 30 (60%) patients who recovered from COVID-19 had most LGE lesions located at the inferolateral (76%, n = 23) and inferior (43%, n = 13) segments. Zhang et al[41], 2022 4 (9%) patients recovered from delta variant COVID-19 had LGE in the mid-wall: 1 (2%), subepicardial: 3 (7%).…”

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confidence: 97%

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CMR Findings in COVID-19 Recovered Patients: A Review on Parametric Mapping, Feature-Tracking, and LGE

Mojica-Pisciotti¹,

Panovský²,

Holeček³

et al. 2022

Rev. Cardiovasc. Med.

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On March 11, 2020, the World Health Organization raised the coronavirus disease 2019 status to a pandemic level. The disease caused a global outbreak with devastating consequences, and a fair percentage of patients who have recovered from it continue experiencing persistent sequelae. Hence, identifying the medium and long-term effects of the COVID-19 disease is crucial for its future management. In particular, cardiac complications, from affected function to myocardial injuries, have been reported in these patients. Considering that cardiovascular magnetic resonance (CMR) imaging is the gold standard in diagnosing myocardial involvement and has more advantages than other medical imaging modalities, assessing the outcomes of patients who recovered from COVID-19 with CMR could prove beneficial. This review compiles common findings in CMR in patients from the general population who recovered from COVID-19. The CMR-based techniques comprised parametric mapping for analyzing myocardial composition, feature tracking for studying regional heart deformation, and late gadolinium enhancement for detecting compromised areas in the cardiac muscle. A total of 19 studies were included. The evidence suggests that it is more likely to find signs of myocardial injury in patients who recovered from COVID-19 than in healthy controls, including changes in T1 and T2 mapping relaxation times, affected strain, or the presence of late gadolinium enhancement (LGE) lesions. However, more than two years after the outbreak, there is still a lack of consensus about how these parameters may indicate cardiac involvement in patients who recovered from the disease, as limited and contradictory data is available.

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Spectrum of lesions visualized in cardiac magnetic resonance imaging in COVID-19-related myocarditis: Findings from a pilot study of the TRICITY-CMR trial

Cited by 6 publications

References 10 publications

Cardiac Magnetic Resonance Findings in Patients Recovered from COVID-19 Pneumonia and Presenting with Persistent Cardiac Symptoms: The TRICITY-CMR Trial

Cardiac Magnetic Resonance Findings in Patients Recovered from COVID-19 Pneumonia and Presenting with Persistent Cardiac Symptoms: The TRICITY-CMR Trial

CMR Findings in COVID-19 Recovered Patients: A Review on Parametric Mapping, Feature-Tracking, and LGE

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