Multimodality Imaging for Cardiac Evaluation in Patients with COVID-19

Abstract

Purpose of Review A growing number of cardiovascular manifestations resulting from the novel SARS-CoV-2 coronavirus (COVID-19) have been described since the beginning of this global pandemic. Acute myocardial injury is common in this population and is associated with higher rates of morbidity and mortality. The focus of this review centers on the recent applications of multimodality imaging in the diagnosis and management of COVID-19-related cardiovascular conditions. Recent Findings In addition to standard cardiac imaging techniques such as transthoracic echocardiography, other modalities including computed tomography and cardiac magnetic resonance imaging have emerged as useful adjuncts in select patients with COVID-19 infection, particularly those with suspected ischemic and nonischemic myocardial injury. Data have also emerged suggesting lasting COVID-19 subclinical cardiac effects, which may have long-term prognostic implications. Summary With the spectrum of COVID-19 cardiovascular manifestations observed thus far, it is important for clinicians to recognize the role, strengths, and limitations of multimodality imaging techniques in this patient population.

COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges

“…48 Thus, appropriate use of a multimodality imaging strategy is most useful to detect ACI and distinguish MI from myocarditis, TTC, pulmonary embolism and other cardiac and chest pathologies in COVID-19 patients. 49,50…”

COVID and Cardiovascular Disease: What We Know in 2021

“…Echocardiography has further refined our understanding of myocardial damage in COVID-19, detailing certain functional patterns of injury [ 14 ]. Szekely and colleagues found right ventricular (RV) dysfunction to be the most common echocardiographic abnormality in a series of 100 hospitalized COVID-19 patients, among nearly 40%, with RV deterioration most associated with clinical decompensations [ 43 ].…”

“…Early case reports described a spectrum of cardiovascular manifestations of COVID-19 infection, including myocarditis, stress cardiomyopathy, myocardial infarction (MI), and arrhythmia [ 9 – 12 ]. In combating a novel disease, the cardiology community deployed its most advanced technology including cardiac magnetic resonance imaging (CMR) which has characterized acute and chronic consequences of SARS-CoV-2 infection [ 13 , 14 ], but often the findings have left clinicians with more questions than answers.…”

COVID-19: The Impact on Cardiovascular System

“…Transthoracic echocardiography (TTE) is the most used imaging modality for cardiac evaluation in COVID-19 as it is can be easily performed at the patient's bedside, providing information about cardiac structure and function [133]. One survey showed that the most common indications for TTE among 1216 examined COVID-19 patients were suspected heart failure, cardiac biomarker elevation and right-sided heart failure (Table 1) [134].…”

“…Moreover, another study showed that the most common findings on TTE were right ventricular (RV) dilation and dysfunction in 39%, followed by left ventricular diastolic dysfunction in 16% and left ventricular systolic dysfunction in only 10% of COVID-19 patients examined within 24 h of admission [128]. A right ventricular impairment that is associated with poor outcomes may be due to extensive use of mechanical ventilation and positive end-expiratory pressures for ARDS patients, as well as hypercoagulability, which both cause damage to lung parenchyma and pulmonary microvasculature resulting in pulmonary hypertension [133,136]. According to a study that included 120 COVID-19 patients right ventricular longitudinal strain (RVLS) is a strong predictor of higher mortality in patients with COVID-19, as patients with impaired RV strain are more prone to ARDS development needing high flow oxygen therapy and mechanical ventilation [137].…”