Myocardial injury in COVID-19: The role of coronary computed tomography angiography (CTA)

Feuchtner, Gudrun; Barbieri, Fabian; Luger, Anna; Skalla, Elisabeth; Kountchev, Jordan; Widmann, Gerlig; Plank, Fabian

doi:10.1016/j.jcct.2020.07.002

Cited by 12 publications

(15 citation statements)

References 3 publications

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“…(1) Acute coronary syndrome (ACS) due to either cytokine mediated plaque instability or inflammatory prothrombotic stage; 91 2) Myocardial mismatch between myocardial demand and consumption of oxygen leading to type 2 myocardial infarction; [92][93][94] (3) Direct cardiac damage mediated by the membrane protein angiotensin converting enzyme 2; 95 (4) Inflammatory myocarditis due to the massive release of interleukin-1 and interluking-6, occurring in the advanced stage of the disease. 96 Due to this complex scenario and due to the overlapping of clinical presentation, interpretation of elevated troponin may be extremely challenging.…”

Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injurymentioning

confidence: 99%

“… 2 , 65 , 66 , 87 , 88 , 89 Of note, patients with elevated cardiac troponin were proved at increased risk of morbidity and mortality compared to patients who did not developed cardiac injury. 89 The causes leading to myocardial injury in COVID-19 are multiple 90 and they can be summarised as follows: Acute coronary syndrome (ACS) due to either cytokine mediated plaque instability or inflammatory prothrombotic stage; 91 Myocardial mismatch between myocardial demand and consumption of oxygen leading to type 2 myocardial infarction; 92 , 93 , 94 Direct cardiac damage mediated by the membrane protein angiotensin converting enzyme 2; 95 Inflammatory myocarditis due to the massive release of interleukin-1 and interluking-6, occurring in the advanced stage of the disease. 96 …”

Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injumentioning

confidence: 99%

“…Myocardial mismatch between myocardial demand and consumption of oxygen leading to type 2 myocardial infarction; 92 , 93 , 94 …”

Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injumentioning

confidence: 99%

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Role of computed tomography in COVID-19

Pontone

Scafuri

Mancini

et al. 2021

Journal of Cardiovascular Computed Tomography

115

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Coronavirus disease 2019 (COVID-19) has become a rapid worldwide pandemic. While COVID-19 primarily manifests as an interstitial pneumonia and severe acute respiratory distress syndrome, severe involvement of other organs has been documented. In this article, we will review the role of non-contrast chest computed tomography in the diagnosis, follow-up and prognosis of patients affected by COVID-19 pneumonia with a detailed description of the imaging findings that may be encountered. Given that patients with COVID-19 may also suffer from coagulopathy, we will discuss the role of CT pulmonary angiography in the detection of acute pulmonary embolism. Finally, we will describe more advanced applications of CT in the differential diagnosis of myocardial injury with an emphasis on ruling out acute coronary syndrome and myocarditis.

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Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injurymentioning

confidence: 99%

Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injumentioning

confidence: 99%

See 1 more Smart Citation

Role of computed tomography in COVID-19

Pontone

Scafuri

Mancini

et al. 2021

Journal of Cardiovascular Computed Tomography

115

View full text Add to dashboard Cite

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“…Acute coronary syndromes with normal or near-normal coronary arteries (ACS-NNOCA), comprising MI with nonobstructive coronary arteries (MINOCA) or MI with normal coronary arteries (MINCA) and ischemic syndromes with non-obstructive coronaries (INOCA), 10 are being increasingly reported in patients with COVID-19 infection (Table 2). [64][65][66] In a case series of 18 COVID-19 patients presenting with STEMI, 3 of 9 (33%) patients undergoing coronary angiography did not have obstructive coronary artery disease (CAD). 67 In an observational study of 118 consecutive confirmed COVID-19 patients (median age 66 years, all men) undergoing transthoracic echocardiography, 5 (4.2%) patients had features compatible with TTC; however, these patients had no coronary angiography to exclude CAD.…”

Section: Acute Coronary Syndromes With Normal or Near-normal Coronariesmentioning

confidence: 99%

“…74 A recent case report described a COVID-19 patient who presented with MINOCA (NSTEMI) and CTCA showed signs of vasculitis with diffuse wall irregularities and focal thickening, which was considered to have triggered endothelial dysfunction and vasospasm. 65 A prospective study enrolled all STEMI patients who underwent primary PCI during the COVID-19 period (83 patients) and compared them with a previous cohort of STEMI patients (2008-2017, n ¼ 1,552 patients); non-COVID-19 patients (n ¼ 72) were also compared with COVID-19 patients (n ¼ 11). 66 Patients during the outbreak period were older, significantly delayed seeking care and sustained a two-fold higher inhospital mortality.…”

Section: Acute Coronary Syndromes With Normal or Near-normal Coronariesmentioning

confidence: 99%

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

Manolis¹,

Manolis

et al. 2021

J Cardiovasc Pharmacol Ther

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In the era of the coronavirus disease 2019 (COVID-19) pandemic, acute cardiac injury (ACI), as reflected by elevated cardiac troponin above the 99th percentile, has been observed in 8%-62% of patients with COVID-19 infection with highest incidence and mortality recorded in patients with severe infection. Apart from the clinically and electrocardiographically discernible causes of ACI, such as acute myocardial infarction (MI), other cardiac causes need to be considered such as myocarditis, Takotsubo syndrome, and direct injury from COVID-19, together with noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis. Acute coronary syndromes (ACS) with normal or near-normal coronary arteries (ACS-NNOCA) appear to have a higher prevalence in both COVID-19 positive and negative patients in the pandemic compared to the pre-pandemic era. Echocardiography, coronary angiography, chest computed tomography and/or cardiac magnetic resonance imaging may render a correct diagnosis, obviating the need for endomyocardial biopsy. Importantly, a significant delay has been recorded in patients with ACS seeking advice for their symptoms, while their routine care has been sharply disrupted with fewer urgent coronary angiographies and/or primary percutaneous coronary interventions performed in the case of ST-elevation MI (STEMI) with an inappropriate shift toward thrombolysis, all contributing to a higher complication rate in these patients. Thus, new challenges have emerged in rendering a diagnosis and delivering treatment in patients with ACI/ACS in the pandemic era. These issues, the various mechanisms involved in the development of ACI/ACS, and relevant current guidelines are herein reviewed.

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

Orbach

Ghugre

Biswas

et al. 2023

Magnetic Resonance Imaging

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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

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Myocardial injury in COVID-19: The role of coronary computed tomography angiography (CTA)

Cited by 12 publications

References 3 publications

Role of computed tomography in COVID-19

Role of computed tomography in COVID-19

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

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

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