Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging

Abstract

Background: Coronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic in ammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiac magnetic resonance imaging (CMRI). However, the middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMRI Methods: A total of 47 recovered COVID-19 patients were prospectively recruited and underwent CMRI examination in this study. The CMRI protocol consisted of black blood fat-suppressed T2 weighted imaging (BB-T2WI), T2 star mapping, left ventricle cine imaging, pre-and post-contrast T1 mapping, and late gadolinium enhancement (LGE). Myocardium edema and LGE were assessed in recovered COVID-19 patients. The left ventricle (LV) and right ventricle (RV) function and LV mass were assessed and compared with normal controls. Results: Finally, 44 recovered COVID-19 patients and 31 normal controls were included in this study. No edema was observed in any patient. LGE was found in 13 patients. All LGE lesions were located in the middle myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had signi cantly decreased left ventricle peak global circumferential strain (LVpGCS), right ventricle peak global circumferential strain (RVpGCS), right ventricle peak global longitudinal strain (RVpGLS) as compared to non-LGE patients (p 0.05), while no difference was detected between the non-LGE patients and normal controls. Conclusion: Myocardium injury existed in about 30% of COVID-19 patients. These patients had peak right ventricle strain that decreased at the 3-month follow-up. Cardiac MRI can monitor the COVID-19-induced myocarditis progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of left ventricle circumferential contraction dysfunction and right ventricular dysfunction.

Cardiac involvement in COVID-19 patients: mid-term follow up by cardiac magnetic resonance imaging

“…Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection by laboratory, autopsy, and CMR [16][17][18] as compared to other members of the coronavirus family 19 . A recent study demonstrated that in the recovered COVID-19 patients with cardiac symptoms, 54% had myocardium edema, and 31% had LGE 11 . In the current study, no edema was observed, which might indicate that all myocardial injury has passed the acute stage at the 3-month follow-up 13,20 .…”

“…Furthermore, impaired RV function has been demonstrated by either echocardiography or CMR 11,31,32 . RV strain has been recommended to assess the RV function in clinical scenarios with suspected RV dysfunction 33 .…”

“…Cardiovascular magnetic resonance imaging (CMRI) can visualize and quantify heart volume and function and characterize the myocardial tissue; thus, it has been used as a gold standard non-invasive imaging tool in cardiovascular medicine 10 . A recent single-center study from Wuhan demonstrated that more than half of the recovered COVID-19 patients sustain cardiac edema, brosis, and impaired right ventricle (RV) contractile function 11 . However, in this small-sample retrospective study, only patients with reported cardiac symptoms were included.…”

Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians

“…10 From available data thus far, it appears there is right ventricular (RV) impairment over left ventricular (LV) involvement in previously hospitalised patients with COVID-19 infection. 11 The incidence of myocarditis associated arrhythmias is unknown, and while COVID-19 infection led to a ≥50% increase in out-of-hospital cardiac arrest in the general population, 12 the data are descriptive and do not necessarily suggest an increased risk of sudden cardiac arrest or arrhythmias in otherwise 'healthy' COVID-19 positive individuals. Animal studies have, however, shown that exercising with myocarditis can increase viral replication and inflammation within the heart, resulting in permanent damage or occasionally sudden death.…”

Cardiopulmonary Considerations for High School Student-Athletes During the COVID-19 Pandemic: NFHS-AMSSM Guidance Statement

“…Student-athletes with ongoing symptoms from diagnosed COVID-19 illness require a comprehensive evaluation to exclude heart and lung disorders that carry a risk of arrhythmia, respiratory compromise, SCA, or sudden death. Specifically, myocarditis may present with ongoing symptoms of chest pain, palpitations, shortness of breath, or exercise intolerance 5,6. Ongoing symptoms from COVID-19 may also indicate pulmonary issues such as acquired or…”