Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance

Abstract

Background Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients. Methods and results One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms). Conclusions During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.

Myocarditis and Other Cardiovascular Complications of the mRNA-Based COVID-19 Vaccines

“…Since December 2019, SARS-CoV-2 has infected over 167 million people worldwide [11]. Cardiac injury, including myocardial infarction, myocarditis, and stress cardiomyopathy, was prevalent in hospitalized patients and portended a worse prognosis [4][5][6]. Myocarditis is defined as myocardial inflammation with histological evidence of inflammatory infiltrates and evidence of necrosis, and may be the result of a variety of etiologies including infections and toxins [12].…”

Long COVID-19: A Primer for Cardiovascular Health Professionals, on Behalf of the CCS Rapid Response Team

“…Small cohort studies utilizing cardiac MRI have reported conflicting results 4,5 , further highlighting the need to better elucidate potential long-term cardiac sequelae of COVID-19, especially as it pertains to patient symptoms and functional impairments. Furthermore, no data presently exist to support or refute the cardiovascular impact of COVID-19 in patients with or without pre-existing cardiac conditions.…”

Utility of Non-invasive Cardiac Imaging Assessment in Coronavirus Disease 2019

“…Among 148 hospitalised patients with severe COVID-19 infection and elevated troponin, outpatient CMR was performed ∼2 months following diagnosis or discharge (60). This showed normal LVEF in 89% of patients, LGE or ischaemia in 54% of patients, of whom 26% had a non-ischaemic pattern and 22% had an ischaemic pattern, and dual pathology was seen in 6%.…”