Early cardiac involvement in patients with acute COVID-19 infection identified by multiparametric cardiovascular magnetic resonance imaging

Abstract

Aims In order to determine acute cardiac involvement in patients with COVID-19, we quantitatively evaluated tissue characteristics and mechanics by non-invasive cardiac magnetic resonance (CMR) in a cohort of patients within the first 10 days of the onset of COVID symptoms. Methods and results Twenty-five patients with reverse transcription polymerase chain reaction confirmed COVID-19 and at least one marker of cardiac involvement [cardiac symptoms, abnormal electrocardiograph (ECG), or abnormal cardiac biomarkers] and 25 healthy age- and gender-matched control subjects were recruited to the study. Patients were divided into those with elevated (n = 8) or normal TnI (n = 17). There were significant differences in global longitudinal strain among patients who were positive and negative for hs-TnI, and controls [−12.3 (−13.3, −11.5)%, −13.1 (−14.2, −9.8)%, and −15.7 (−18.3, −12.7)%, P = 0.004]. Native myocardial T1 relaxation times in patients with positive and negative hs-TnI manifestation (1169.8 ± 12.9 and 1113.2 ± 31.2 ms) were significantly higher than the normal (1065 ± 57 ms) subjects, respectively (P < 0.001). The extracellular volume (ECV) of patients who were positive and negative for hs-TnI was higher than that of the normal controls [32 (31, 33)%, 29 (27, 30)%, and 26 (24, 27.5)%, P < 0.001]. In our study, quantitative T2 mapping in patients who were positive and negative for hs-TnI [51 (47.9, 52.8) and 48 (47, 49.4) ms] was significantly higher than the normal [42 (41, 45.2) ms] subjects (P < 0.001). Conclusion In patients with early-stage COVID-19, myocardial oedema, and functional abnormalities are a frequent finding, while irreversible regional injury such as necrosis may be infrequent.

Cardiac inflammation and microvascular procoagulant changes are decreased in second wave compared to first wave deceased COVID-19 patients

“…Elevated blood levels of cardiac Troponins and Creatine Kinase MB, indicative for acute myocardial injury, were found in 5% to 38% of hospitalized COVID-19 patients [2] and appear to associate with a fatal outcome [5]. In addition, cardiac magnetic resonance imaging studies have revealed myocardial abnormalities, including scar formation and myocardial edema, in patients with ongoing [6,7] and who recently recovered from COVID-19 [8]. Histopathological studies have shown increased cardiac inflammation consisting of infiltrating lymphocytes, macrophages and neutrophils, either or not coinciding with focal cardiomyocyte injury, in autopsied hearts of deceased COVID-19 patients [3,4,9,10] and in endomyocardial biopsies (EMB) of living COVID-19 patients [11,12], although some controversy exists about the incidence of myocarditis in COVID-19 patients [13][14][15].…”

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

“…Recent studies have reported on structural myocardial damage in patients who have suffered a COVID-19 infection in the form of acute myocarditis or myocardial scar formation ( 2 , 6 – 11 ). Puntmann et al demonstrated that about 78% of recently recovered COVID-19 patients had abnormal cardiac magnetic resonance (MRI) findings including increased native T1 and T2 myocardial relaxation times, decreased ejection fractions, and increased left ventricular volumes ( 8 ).…”

Cardiovascular magnetic resonance findings in non‐hospitalized paediatric patients after recovery from COVID‐19

“…Especially myocardial oedema might have not been detected in our study more than 1 month after symptom onset. 3 In children, the cardiac involvement after mild COVID‐19 infections was lower compared with studies in adults with mild or moderate COVID‐19 infections, where high frequencies of CMR manifestations (30–78%) as ongoing myocardial inflammation, positive late gadolinium enhancement, and LV dysfunction were reported. 1 , 2 The minimal pericardial effusion might be a sign of mild pericarditis in this paediatric cohort, which could also be detected in adults studies in wide range of 0–58% within 10 studies.…”

“…Recent cardiovascular magnetic resonance (CMR) studies have reported frequent cardiac injury in adults with COVID‐19 infections. 1 , 2 , 3 Data in paediatric patients are limited and mainly related to the occurrence of multisystem inflammatory syndrome in children associated with SARS‐CoV‐2 infection (MISc), which presents mostly with a severe onset. 4 , 5 , 6 , 7 The prevalence and clinical role of cardiac injury in paediatric COVID‐19 patients without systemic inflammation is not well studied using sensitive methods for myocardial tissue characterization.…”