Low Prevalence of Late Myocardial Injury on Cardiac MRI Following COVID‐19 Infection

Abstract

BackgroundThe prevalence of abnormal cardiac magnetic resonance imaging (MRI) findings indicative of myocardial injury in patients who recovered from coronavirus disease 2019 (COVID‐19) is currently unclear, with a high variability in the reported prevalence.PurposeTo assess the prevalence of myocardial injury after a COVID‐19 infection.Study TypeProspective, bicentric study.SubjectsSeventy consecutive patients who recovered from COVID‐19 and were previously hospitalized. Mean age was 57 years and 39% of the patients were female. Ten healthy controls and a comparator group of 75 nonischemic cardiomyopathy (NICM) patients were employed.Field Strength/Sequence1.5‐T, steady‐state free precession (SSFP) gradient‐echo sequence, modified Look‐Locker inversion recovery sequence with balanced SSFP readout, T2‐prepared spiral readout sequence and a T1‐weighted inversion recovery fast gradient‐echo sequence was acquired ~4–5 months after recovery from COVID‐19.AssessmentThe SSFP sequence was utilized for the calculation of left and right ventricular volumes and ejection fractions (LVEF and RVEF) following manual endocardial contouring. T1 and T2 mapping was performed by pixel‐wise exponential fitting, and T1 and T2 values were computed by manual contouring of the left ventricular endocardial and epicardial walls. Late gadolinium enhancement (LGE) images were graded qualitatively as LGE present or absent.Statistical TestsT‐tests and the χ2 or Fisher's exact tests were used to compare continuous and categorical variables respectively between the COVID‐19 and NICM groups. Inter‐rater agreement was evaluated by the intraclass correlation coefficient for continuous variables and Cohen's kappa test for LGE.ResultsReduced RVEF occurred in 10%, LGE and elevated native T1 in 9%, reduced LVEF in 4%, and elevated T2 in 3% of COVID‐19 patients, respectively. Patients with NICM had lower mean LVEF (41.6% ± 6% vs. 60% ± 7%), RVEF (46% ± 5% vs. 61% ± 9%), and a significantly higher prevalence of LGE (27% vs. 9%) when compared to those post‐COVID‐19.Data ConclusionAbnormal cardiac MRI findings may show a low prevalence in patients who recovered from COVID‐19 and were previously hospitalized.Level of Evidence2Technical EfficacyStage 2

Three Years of COVID-19 Pandemic—Is the Heart Skipping a Beat?

“…Importantly, it is well known that angiotensin-converting enzyme 2 plays a central role in the processes of inflammation, oxidative stress, vasoconstriction and fibrosis [18], as well as the affinity of SARS-CoV 2 virus to angiotensin-converting enzyme 2 receptor with the hyperactivation of the renin-angiotensin-aldosterone system, thereby promoting the inflammation process [19]. The mixed effect of the direct viral effect and the inflammation process with cytokine storm, endothelitis and thrombosis occurring at different stages in the evolution of the disease represent the substrate for cardiac injury [10] Subsequently, some patients recovering from COVID-19 may develop long-term consequences with a variable prevalence at different time points [20]. For example, post-COVID lymphocytic and eosinophilic myocarditis was reported between one and five months following the acute infection, with SARS-CoV-2 ribonucleic acid (RNA) being detected in association with parvovirus B19 DNA [21].…”