Cardiac involvement in coronavirus disease 2019 assessed by cardiac magnetic resonance imaging: a meta-analysis

Abstract

In this systematic review and meta-analysis, we sought to evaluate the prevalence of cardiac involvement in patients with COVID-19 using cardiac magnetic resonance imaging. A literature review was performed to investigate the left ventricular (LV) and right ventricular (RV) ejection fraction (EF), the prevalence of LV late gadolinium enhancement (LGE), pericardial enhancement, abnormality on T1 mapping, and T2 mapping/T2-weighted imaging (T2WI), and myocarditis (defined by modified Lake Louis criteria). Pooled mean differences (MD) between COVID-19 patients and controls for LVEF and RVEF were estimated using random-effects models. We included data from 10.462 patients with COVID-19, comprising 1.010 non-athletes and 9.452 athletes from 29 eligible studies. The meta-analysis showed a significant difference between COVID-19 patients and controls in terms of LVEF [MD = − 2.84, 95% confidence interval (CI) − 5.11 to − 0.56, p < 0.001] and RVEF (MD = − 2.69%, 95% CI − 4.41 to − 1.27, p < 0.001). However, in athletes, no significant difference was identified in LVEF (MD = − 0.74%, 95% CI − 2.41 to − 0.93, p = 0.39) or RVEF (MD = − 1.88%, 95% CI − 5.21 to 1.46, p = 0.27). In non-athletes, the prevalence of LV LGE abnormalities, pericardial enhancement, T1 mapping, T2 mapping/T2WI, myocarditis were 27.5% (95%CI 17.4–37.6%), 11.9% (95%CI 4.1–19.6%), 39.5% (95%CI 16.2–62.8%), 38.1% (95%CI 19.0–57.1%) and 17.6% (95%CI 6.3–28.9%), respectively. In athletes, these values were 10.8% (95%CI 2.3–19.4%), 35.4% (95%CI − 3.2 to 73.9%), 5.7% (95%CI − 2.9 to 14.2%), 1.9% (95%CI 1.1–2.7%), 0.9% (0.3–1.6%), respectively. Both LVEF and RVEF were significantly impaired in COVID-19 patients compared to controls, but not in athletes. In addition, the prevalence of myocardial involvement is not negligible in patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s00380-022-02055-6.

Advanced cardiac imaging in the spectrum of COVID-19 related cardiovascular involvement

“…Kato et al [28] published an updated meta-analysis in 2022 that included 10.462 COVID-19 patients who underwent CMR and found a minimal reduction in left (− 2.84%) and right (− 2.69%) ventricular ejection fraction in COVID-19 patients compared to controls, with LV LGE abnormalities in 27.5%, pericardial involvement in 11.9%, T1 mapping alteration in 39.5%, T2 mapping or T2-weighted sequences alterations in 38.1%, with a prevalence of myocarditis of 17.6%. These confirm that LV involvement is common in COVID-19 patients, CMR is useful in detecting cardiac abnormalities, and myocarditis is the most common finding.…”

“…Cardiac Magnetic Resonance (CMR) is the imaging of choice for the non-invasive characterization of myocardium, allowing to accurately assess ventricular function, myocardial edema, and myocardial injury. CMR imaging is useful for the non-invasive detection of cardiac alteration related to acute COVID-19, post-acute sequelae, and vaccination [28].…”

Prevalence and impact of myocardial injury among patients hospitalized with COVID-19

“…This persistence may result in a higher risk of heart failure, arrhythmias, and mortality ( 24 ). Recent evidence supports this hypothesis, showing that 60% of recovered COVID-19 patients exhibited signs of myocarditis on cardiac magnetic resonance imaging ( 26 ). To the best of our knowledge, this study had the longest follow-up period (median 18.4 months).…”

Multimodality Cardiac Imaging in COVID-19 Infection

“…Of these people, a significant proportion may have some myocardial damage; the latest available studies and metanalyses estimate this number to fall between 15–40%. It is likely that the real percentage favors the lower end because of the many undiagnosed cases; however, it still represents a very high total number of cases [ 38 , 49 , 50 ].…”