Cardiac MRI in Patients with Prolonged Cardiorespiratory Symptoms after Mild to Moderate COVID-19

Abstract

Background Myocardial injury and inflammation on cardiac MRI in patients suffering from coronavirus disease 19 (COVID-19) have been described in recent publications. Concurrently, a chronic COVID-19 syndrome (CCS) after COVID-19 infection has been observed manifesting with symptoms like fatigue and exertional dyspnea. Purpose To explore the relationship between CCS and myocardial injury and inflammation as an underlying cause of the persistent complaints in previously healthy individuals. Materials and Methods In this prospective study from January 2021 to April 2021, study participants without known cardiac or pulmonary diseases prior to COVID-19 infection with persisting CCS symptoms like fatigue or exertional dyspnea after convalescence and healthy control participants underwent cardiac MRI. Cardiac MRI protocol included T1 and T2 relaxation times, extracellular volume (ECV), T2 signal intensity ratio, and late gadolinium enhancement (LGE). Student t test, Mann-Whitney U test, and χ 2 test were used for statistical analysis. Results 41 participants with CCS (39±13 years; 18 men) and 42 control participants (39±16 years; 26 men) were evaluated. Median time between initial mild to moderate COVID-19 disease without hospitalization and cardiac MRI was 103 days (interquartile range: 88-158). Troponin T levels were normal. Parameters indicating myocardial inflammation and edema were comparable between participants with CCS and control participants: T1 relaxation time (978±23 ms vs 971±25 ms; P=.17), T2 relaxation time (53±2 ms vs 52±2 ms; P=.47), T2 signal intensity ratio (1.6±0.2 vs 1.6±0.3; P=.10). Visible myocardial edema was present in none of the participants. Three of 41 (7%) participants with CCS demonstrated non-ischemic LGE compared to none in the control group (0 of 42 [0%]; P=.07). None of the participants fulfilled the 2018 Lake Louise criteria for the diagnosis of myocarditis. Conclusion Individuals without hospitalization for COVID-19 and with CCS did not demonstrate signs of active myocardial injury or inflammation on cardiac MRI. See also the editorial by Lima and Bluemke .

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

“…Four of the studies presented two cohorts [ 8 , 10 , 21 , 31 ]; therefore, we included a total of 33 independent cohorts. Among the 29 included studies, nine were from the USA [ 8 , 15 , 20 , 22 , 24 , 32 , 36 – 38 ], six were from China [ 10 , 11 , 16 , 18 , 21 , 30 ], three each from the UK [ 19 , 22 , 26 ] and Germany [ 7 , 23 , 28 , 35 ], two each from Italy [ 9 , 27 ] and Turkey [ 29 , 31 ], and one each from Poland [ 17 ], Norway [ 34 ], Hungary [ 33 ] and Spain [ 25 ]. The publication year was 2020 or 2021 ( Table 1 ).…”

“…Finally, 10.462 patients with COVID-19, including 1010 non-athletes and 9.452 athletes, and 746 controls were included in our analysis. A 1.5 T MR scanner was used in 15 studies [ 8 , 9 , 11 , 15 , 17 , 22 – 26 , 28 , 29 , 33 – 35 ] and a 3.0 T MR scanner was used in six studies [ 7 , 10 , 16 , 18 , 21 , 30 ], Both 1.5 T and 3.0 T scanners were used in one study [ 20 ] and data regarding MR scanners were not provided in seven studies [ 19 , 27 , 31 , 32 , 36 – 38 ]. As the myocardial native T1 time substantially differs between different magnetic field strengths and sequences [ 39 ], we investigated the number patients with abnormal T1 time, rather than those with absolute value of native T1 time, among the nine studies presenting the prevalence of patients with abnormal native T1 times [ 7 – 9 , 11 , 17 , 22 , 26 , 27 , 32 ].…”

Combined Cardiac Fluorodeoxyglucose–Positron Emission Tomography/Magnetic Resonance Imaging Assessment of Myocardial Injury in Patients Who Recently Recovered From COVID-19

“…Several cardiac magnetic resonance imaging (MRI) studies have examined myocardial disease in patients who had recovered from COVID-19 [4][5][6][7] and have reported a broad range in prevalence of abnormal myocardial tissue characteristics (7%-73%). 5,6,8 However, there is limited understanding of persistent changes in myocardial metabolism in recovered patients, which is a potential concern given that COVID-19 is associated with systemic inflammation during the acute illness. Combined cardiac 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/MRI can reliably characterize myocardial inflammation and its relationship to myocardial abnormalities on MRI.…”

Functional Capacity in Patients Who Recovered from Mild COVID-19 with Exertional Dyspnea

“…Regarding cardiac damage that cannot be demonstrated in routine tests, in a cohort of 100 patients who recovered from COVID-19, 78% had cardiovascular involvement as detected by standardized cardiac MRI, irrespective of pre-existing conditions, the severity and overall course of the COVID-19 presentation, the time from the original diagnosis, or the presence of cardiac symptoms [ 42 ]. On the other hand, among 41 patients with dyspnea who had mild COVID-19 and were not hospitalized and 42 control participants, parameters indicating myocardial inflammation and edema were comparable between patients and control with no visible myocardial edema in any of the participants [ 43 ].…”