Cardiac involvement in patients recovering from Delta Variant of COVID‐19: a prospective multi‐parametric MRI study

Abstract

AimsThe cardiac injury and sequelae of Delta Variant of coronavirus disease 2019 remain unknown. This study aimed to evaluate the presence of cardiac involvement in patients recovering from Delta Variant of COVID-19 based on multiparametric cardiac magnetic resonance imaging (MRI). Methods and resultsWe prospectively assessed patients recovering from Delta Variant of COVID-19 using multi-parametric cardiac magnetic resonance imaging (MRI) between June 2021 and July 2021. Comparison was made with 25 healthy controls. Forty-four patients (median age 51 years, 28 women) recovering from Delta Variant were recruited and had a median time of 35 days between diagnosis and cardiac MRI. There were no patients with chest pain (0/44, 0%) and high sensitivity cardiac troponin T troponin elevation (median levels 2.20 pg/mL, IQR levels 0.85-4.40 pg/mL). Regarding the cardiac imaging findings, a total of 14 (32%) patients presented cardiac tissue feature abnormalities, and a total of 9 (20%) patients had a myocarditis-like injury based on cardiac MRI 2018 Lake Louise criteria. When we further assessed the T1 and T2 mapping values for of patients' individual, abnormal raised global native T1, T2, and extracellular volume were seen in 6 (14%), 6 (14%), and 4 (9%) patients, respectively. Comparing with controls, the patients had lower LV global longitudinal strain and (À22.2 ± 2.8% vs. À24.6 ± 2.0%, P < 0.001) and global circumferential strain (À20.7 ± 6.8% vs. À24.3 ± 2.9%, P = 0.014), but higher global native T1 (1318.8 ± 55.5 ms vs. 1282.9 ± 38.1 ms, P = 0.006). Four (9%) patients presented myocardial late gadolinium enhancement with subepicardial pattern mostly common seen, and two (5%) patients presented pericardial enhancement. Conclusions The cardiac MRI could detect subclinical functional and myocardial tissue characteristic abnormalities in individuals who were recovering from Delta Variant without cardiac-related clinical findings. The native T1 mapping and strain imaging may be a sensitive tool for the noninvasive detection of a subset of patients who are at risk for cardiac sequelae and more prone to myocardial damage in survivors with Delta Variant.

COVID-19 Infections in Adults with Congenital Heart Disease—A Prospective Single-Center Study in an Outpatient Setting

“…In patients recovered from COVID-19, cardiac involvement with ongoing inflammation on CMR has been described in patients with and without cardiac symptoms [ 12 , 13 , 25 ]. A recent study confirmed these findings in patients recovering from the Delta variant of COVID-19 [ 26 ]. In our study, none of the patients who underwent CMR showed cardiac involvement.…”

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

“…Fewer studies reported significantly higher ECV in patients who recovered from COVID-19, particularly those with a severe disease manifestation [27,31]. Other authors found similar values between recovered subjects and controls [4,29,30,32,41]. The pooled effect size for ECV measured at 1.5 T was -0.32 (95% CI -0.54 to -0.11) and was statistically significant (p = 0.0169).…”

“…Studies including patients who recovered from COVID-19 reported increased [4,27,28,33,35,36], slightly increased [29,32,38,39,41] or similar [31,34] T1 native mapping values compared to controls. In particular, Kotecha et al [28], Puntmann et al [35], and Thornton et al [37] found significantly higher T1 native mapping values in large groups of recovered subjects (148, 100 and 90, respectively) compared to different control groups, including patients without myocardial injury, healthy volunteers or controls, and risk factor-matched controls [26,28,35,37].…”

“…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]).…”

Myocardial Injuries in COVID-19: More Questions Than Answers

“…The correlation between myocardial injuries detected by troponin elevation and myocardial injury detected by imaging techniques such as cardiac resonance is also controversial. Abnormalities have been described in cardiac magnetic resonance performed in the subacute phase of the disease in patients in whom troponin elevations had not been detected in an acute phase, which is somewhat surprising [ 11 ].…”