Cardiovascular Magnetic Resonance for Patients With COVID-19

Abstract

COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19–related myocarditis is likely infrequent, COVID-19–related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post–COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19–related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

“…In symptomatic patients, CMR is the most sensitive method to exclude ischemia and preexisting cardiomyopathies 106 while confirming cardiac changes due to SARS-CoV-2 infection, including myocardial inflammation, nonischemic epicardial scar, and pericardial effusion/enhancement, all of which are demonstrable after 4 weeks. 106 , 107 For patients who are unstable or exhibit high-risk features (eg, hypotension, ventricular arrhythmias), evaluation at an advanced heart failure center is recommended. Endomyocardial biopsy should be considered in those with clinical deterioration, particularly if heart block or ventricular arrhythmias are present and obstructive coronary artery disease has been excluded.…”

Post-COVID-19 Syndrome: Involvement and Interactions between Respiratory, Cardiovascular and Nervous Systems

“…Specifically, reports of myocardial damage in association with COVID-19 comprise acute ischemic injury (type 1 myocardial infarction) [58], along with non-ischemic injury (i.e., myocarditis) [59,60], stress cardiomyopathy [61], heart failure (HF) [62] and secondary cardiac injury caused by sepsis and critical illness [63] (Figures 1 and 2). Mechanisms of myocardial injury may be indirect via systemic inflammatory response or direct (viral infection, thought to be less common) [64]. Specifically, autopsy studies on 39 COVID-19 patients identified virus in the heart tissue of 62.5% of patients [65].…”

“…Palpitations and chest pain are the most common subjective findings [9]. A study by Frankfurt University Hospital revealed that 78% of survivors of COVID-19 had CV alterations, and 60% of them still showed signs of persistent myocardial inflammation Mechanisms of myocardial injury may be indirect via systemic inflammatory response or direct (viral infection, thought to be less common) [64]. Specifically, autopsy studies on 39 COVID-19 patients identified virus in the heart tissue of 62.5% of patients [65].…”

Editorial commentary: COVID-19 as a cardiovascular disease risk factor

“…In addition, it can be attributed to sepsis or exacerbation of preexisting chronic conditions such as cardiomyopathy. [ 4 , 5 ] Of note, more than one etiology may coexist in the same patient. A complex interplay of multiple mechanisms appears to underlie COVID-19-mediated myocardial injury.…”

“… [5] CMR is a highly sensitive diagnostic tool in evaluating COVID-19-associated myocardial involvement findings such as inflammation, late gadolinium enhancement, nonischemic epicardial scar, and pericardial effusion. [ 4 , 5 ]…”