Cardiac MRI in Suspected Acute COVID-19 Myocarditis

Luetkens, Julian A.; Isaak, Alexander; Öztürk, Can; Mesropyan, Narine; Monin, Malte B; Schlabe, Stefan; Reinert, Matthäus; Faron, Anton; Heine, Annkristin; Velten, Markus; Dabir, Darius; Boesecke, Christoph; Strassburg, Christian P.; Attenberger, Ulrike; Zimmer, Sebastian; Duerr, Georg Daniel; Nattermann, Jacob

doi:10.1148/ryct.2021200628

Cited by 31 publications

(39 citation statements)

References 6 publications

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“…Conversely, late gadolinium enhancement (as an indirect sign of necrosis) was lower in COVID-19 myocarditis, suggesting that the pathophysiology of SARS-CoV-2 involves a unique interplay of inflammatory pathways, irrespective of underlying structural disease. 7 The differences between cardiac MRI studies in COVID-19 are multifactorial and the timing of image acquisition may partially explain the contrasts between previous publications and this study. Patients were enrolled by Singh et al in the late post-discharge period, with a median 116 days since symptom onset.…”

Section: Editorialcontrasting

confidence: 53%

“…6 Also in its early phases, COVID-19 myocarditis differed from other patterns of cardiac inflammation when compared with acute non-COVID-19 myocarditis and healthy individuals. 7 Diffuse myocardial oedema impacting LV function with lower LVEF was present in eight patients with signs of…”

Section: Cardiac Involvement In Covid-19: Cause or Consequence Of Severe Manifestations?mentioning

confidence: 99%

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Cardiac involvement in COVID-19: cause or consequence of severe manifestations?

Nascimento

Sable

2021

Heart

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Section: Editorialcontrasting

confidence: 53%

Section: Cardiac Involvement In Covid-19: Cause or Consequence Of Severe Manifestations?mentioning

confidence: 99%

Cardiac involvement in COVID-19: cause or consequence of severe manifestations?

Nascimento

Sable

2021

Heart

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Section: Discussionmentioning

confidence: 99%

“…Thus, the original LLC was revised with mapping techniques in the acute myocarditis diagnosis in 2018. 28 The patients with symptomatic COVID-19 and acute myocarditis were found to have a pattern of diffuse myocardial edema in CMR evaluation, 29,30 but in following clinical change details of CMR are rather limited. 31 However, in subacute/chronic period, CMR's limitation in diagnosing myocarditis is the evolving nature of myocardial edema and necrosis over time after the initial insult.…”

mentioning

confidence: 99%

Laboratory and Imaging Evaluation of Cardiac Involvement in Patients with Post-Acute COVID-19

Sarıçam¹,

Dursun²,

Sarıyıldız³

et al. 2021

IJGM

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Background In the post-acute COVID-19 syndrome, many patients suffer from palpitations, effort-associated fatigue, and even sudden death. The mechanism of heart involvement in this syndrome is uncertain. The main purpose of the study was to identify possible cardiac involvement causes in patients with post-acute COVID-19 by using biomarkers such as NT-proBNP and nitric oxide (NO) and cardiac imaging modalities. Methods In this cross-sectional study, a total of 105 participants were included according to the existence of symptoms, and 40 of these participants were asymptomatic patients. The ages of the participants ranged from 20 to 50 years. All patients were healthy before COVID-19. The symptoms were defined as palpitations and/or fatigue association with exercise in post-acute COVID-19 term. The comparison of the two groups was made by using biochemical parameters (NT-proBNP, Troponin I, NO) and imaging techniques (echocardiography, cardiovascular magnetic resonance (CMR) and cardiac positron emission tomography (PET)). Results The symptomatic patients had higher NT-proBNP levels compared with asymptomatic patients (132.30±35.15; 76.86±16.79, respectively; p < 0.001). Interestingly, the symptomatic patients had lower NO levels than asymptomatic patients (9.20±3.08; 16.15±6.02, respectively; p < 0.001). Echocardiography and CMR were normal. However, we found regional increased 18F-FDG uptake on cardiac PET to be compatible with myocardial fatigue. Conclusion We found elevated NT-proNBP levels, low serum NO levels, and increased 18F-FDG uptake on cardiac PET in post-acute COVID syndrome. Cardiac PET could replace or be added to CMR for detecting subtle subacute/chronic myocarditis. The follow-up of patients with post-acute COVID-19 could target the possibility of risk of heart failure.

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“…Imaging findings of COVID-19 related myocarditis on CMRI include; myocardial dysfunction including impaired LVEF, systolic strain, pericardial enhancement with or without effusion, diffuse myocardial edema seen on T1 and T2, late gadolinium enhancement, and signs of stress induced cardiomyopathy with subendocardial edema and enhancement [ 8 ]. CMRI findings for COVID-19 are recognized by revised Lake Louise consensus criteria [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Myocarditis: Rationale for Early Diagnosis and Intervention

Fatmi

Basso

Liaqat

et al. 2021

Cureus

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Myocarditis is a common cardiovascular manifestation seen in patients diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, because of the similarity of presentation with other cardiopulmonary pathologies, identification of coronavirus disease 2019 (COVID-19) related myocarditis can be challenging. Transthoracic echocardiography is a key component in initial diagnosis. COVID-19 related myocarditis is increasingly identified as an underlying problem in COVID-19 patients with low ejection fraction. Early recognition is critical with a low threshold for screening echocardiogram. Utilization of cardiac MRI (CMRI) can be helpful in recognition of early manifestations of COVID-19 myocarditis, with the added benefit of avoidance of invasive testing such as endomyocardial biopsy (EMB). Once diagnosis is established, disease-specific treatment can lead to rapid recovery of ventricular systolic function. We present a case series including two similar cases of COVID-19 myocarditis in which we utilized echocardiography as an early diagnostic tool and prompt treatment led to better prognosis.

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Cardiac MRI in Suspected Acute COVID-19 Myocarditis

Abstract: Keywords: COVID-19; coronavirus; myocarditis; cardiac MRI; T1 mapping; T2 mapping

Cited by 31 publications

References 6 publications

Cardiac involvement in COVID-19: cause or consequence of severe manifestations?

Cardiac involvement in COVID-19: cause or consequence of severe manifestations?

Laboratory and Imaging Evaluation of Cardiac Involvement in Patients with Post-Acute COVID-19

COVID-19 Myocarditis: Rationale for Early Diagnosis and Intervention

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