The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients

Borlotti, Alessandra; Thomaides-Brears, Helena; Georgiopoulos, Georgios; Banerjee, Rajarshi; Robson, Matthew D; Fusco, Dahlene N.; Masci, Pier Giorgio

doi:10.3389/fcvm.2022.854750

Cited by 4 publications

(6 citation statements)

References 74 publications

(84 reference statements)

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“…We report prevalence of CMR abnormalities (19% and 15% at 6 and 12 months) consistent with previous studies, providing standardisation of metrics and definition, which can be used at scale in research and practice to document and monitor cardiac abnormalities 6 11 16 19 20. We confirm that abnormalities in T1 (in line with previous research,6 9–11 19 22 T2 and LGE, as well as functional abnormalities,5 11 23 24 are most common in Long COVID patients. Acute COVID can present with myocardial inflammation; ongoing COVID-19 patients can also have myocarditis, but it is harder to diagnose, and often missed with echocardiography.…”

Section: Discussionsupporting

confidence: 89%

“…4 5 17 18 Published CMR studies in Long COVID vary by study design, cohort, follow-up duration, definition of cardiac abnormalities and estimated prevalence of cardiac abnormalities (26%-60%). 6 11 19-23 A recent review 9 highlighted under-representation of affected individuals from community-based settings, especially monitoring nonhospitalised individuals over time, which we address in this study. When COVID-19-related and classical myocardial injury are compared, 8 only 9% of individuals fulfil acute myocarditis criteria and those with more severe disease are more likely to exhibit chronic inflammation and impaired cardiac function.…”

Section: Characteristics and Trajectory Of Cardiac Abnormalitiesmentioning

confidence: 99%

“…A systematic review of CMR findings post-COVID-19 identified myocarditis as the most prevalent diagnosis (14%),6 though not all classical features are evident on biopsy,7 8 and T1 abnormalities and oedema on T2 as the most common findings, and occasional late gadolinium enhancement (LGE) 8. These findings may be present even in absence of elevated cardiac blood biomarkers (eg, troponin or NT-pro-BNP, natriuretic peptide pro B-type natriuretic peptide) 6 9 10. Pericardial effusion and reduced LV and RV function have been occasionally reported, but pericarditis is rare.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection

Fernandez¹,

Wamil

Telford³

et al. 2023

Open Heart

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BackgroundLong COVID is associated with multiple symptoms and impairment in multiple organs. Cross-sectional studies have reported cardiac impairment to varying degrees by varying methodologies. Using cardiac MR (CMR), we investigated a 12-month trajectory of abnormalities in Long COVID.ObjectivesTo investigate cardiac abnormalities 1-year post-SARS-CoV-2 infection.Methods534 individuals with Long COVID underwent CMR (T1/T2 mapping, cardiac mass, volumes, function and strain) and multiorgan MRI at 6 months (IQR 4.3–7.3) since first post-COVID-19 symptoms. 330 were rescanned at 12.6 (IQR 11.4–14.2) months if abnormal baseline findings were reported. Symptoms, questionnaires and blood samples were collected at both time points. CMR abnormalities were defined as ≥1 of low left or right ventricular ejection fraction (LVEF), high left or right ventricular end diastolic volume, low 3D left ventricular global longitudinal strain (GLS), or elevated native T1 in ≥3 cardiac segments. Significant change over time was reported by comparison with 92 healthy controls.ResultsTechnical success of multiorgan and CMR assessment in non-acute settings was 99.1% and 99.6% at baseline, and 98.3% and 98.8% at follow-up. Of individuals with Long COVID, 102/534 (19%) had CMR abnormalities at baseline; 71/102 had complete paired data at 12 months. Of those, 58% presented with ongoing CMR abnormalities at 12 months. High sensitivity cardiac troponin I and B-type natriuretic peptide were not predictive of CMR findings, symptoms or clinical outcomes. At baseline, low LVEF was associated with persistent CMR abnormality, abnormal GLS associated with low quality of life and abnormal T1 in at least three segments was associated with better clinical outcomes at 12 months.ConclusionCMR abnormalities (left entricular or right ventricular dysfunction/dilatation and/or abnormal T1mapping), occurred in one in five individuals with Long COVID at 6 months, persisting in over half of those at 12 months. Cardiac-related blood biomarkers could not identify CMR abnormalities in Long COVID.Trial registration numberNCT04369807.

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Section: Discussionsupporting

confidence: 89%

Section: Characteristics and Trajectory Of Cardiac Abnormalitiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection

Fernandez¹,

Wamil

Telford³

et al. 2023

Open Heart

Self Cite

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“…MR metrics were standardised to deliver a single report interpretable by clinicians. Each report included 49 organ-specific metrics with reference ranges to determine impairment (updated from our prior study 10 ) after determining distribution of each metric in healthy controls matched for age and sex ( n = 92) and for organ volumes from healthy controls representing complete sex and height subgroups ( N = 1835) in this study and UK Biobank 13 (Tables S1a and S1b). Repeatability of the metrics was evaluated in the healthy controls using standardised performance testing criteria.…”

Section: Diagnostic Assessment In Non-acute Settingsmentioning

confidence: 99%

“…9 Clinical utility of these MRI metrics for chronic and multi-system conditions has been shown. 10,11 More severe ongoing symptoms of breathlessness and fatigue were associated with myocarditis (p < 0.05) 9 , but symptoms and multi-organ manifestations have not been correlated.…”

Section: Introductionmentioning

confidence: 98%

Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study

et al. 2023

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Objectives To determine the prevalence of organ impairment in long COVID patients at 6 and 12 months after initial symptoms and to explore links to clinical presentation. Design Prospective cohort study. Participants Individuals. Methods In individuals recovered from acute COVID-19, we assessed symptoms, health status, and multi-organ tissue characterisation and function. Setting Two non-acute healthcare settings (Oxford and London). Physiological and biochemical investigations were performed at baseline on all individuals, and those with organ impairment were reassessed. Main outcome measures Primary outcome was prevalence of single- and multi-organ impairment at 6 and 12 months post COVID-19. Results A total of 536 individuals (mean age 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post COVID-19); 331 (62%) with organ impairment or incidental findings had follow-up, with reduced symptom burden from baseline (median number of symptoms 10 and 3, at 6 and 12 months, respectively). Extreme breathlessness (38% and 30%), cognitive dysfunction (48% and 38%) and poor health-related quality of life (EQ-5D-5L < 0.7; 57% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single-organ impairment. Single- and multi-organ impairment were present in 69% and 23% at baseline, persisting in 59% and 27% at follow-up, respectively. Conclusions Organ impairment persisted in 59% of 331 individuals followed up at 1 year post COVID-19, with implications for symptoms, quality of life and longer-term health, signalling the need for prevention and integrated care of long COVID. Trial Registration: ClinicalTrials.gov Identifier: NCT04369807

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Multi-organ impairment and Long COVID: a 1-year prospective, longitudinal cohort study

Dennis¹,

Cuthbertson

Wootton

et al. 2022

Preprint

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ImportanceMulti-organ impairment associated with Long COVID is a significant burden to individuals, populations and health systems, presenting challenges for diagnosis and care provision. Standardised assessment across multiple organs over time is lacking, particularly in non-hospitalised individuals.ObjectiveTo determine the prevalence of organ impairment in Long COVID patients at 6 and at 12 months after initial symptoms and to explore links to clinical presentation.DesignThis was a prospective, longitudinal study in individuals following recovery from acute COVID-19. We assessed symptoms, health status, and multi-organ tissue characterisation and function, using consensus definitions for single and multi-organ impairment. Physiological and biochemical investigations were performed at baseline on all individuals and those with organ impairment were reassessed, including multi-organ MRI, 6 months later.SettingTwo non-acute settings (Oxford and London).Participants536 individuals (mean 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post-COVID-19). 331 (62%) with organ impairment or incidental findings had follow up, with reduced symptom burden from baseline (median number of symptoms: 10 and 3, at 6 and 12 months).ExposureSARS-CoV-2 infection 6 months prior to first assessment.Main outcomePrevalence of single and multi-organ impairment at 6 and 12 months post-COVID-19.ResultsExtreme breathlessness (36% and 30%), cognitive dysfunction (50% and 38%) and poor health-related quality of life (EQ-5D-5L<0.7; 55% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single organ impairment. At baseline, there was fibro-inflammation in the heart (9%), pancreas (9%), kidney (15%) and liver (11%); increased volume in liver (7%), spleen (8%) and kidney (9%); decreased capacity in lungs (2%); and excessive fat deposition in the liver (25%) and pancreas (15%). Single and multi-organ impairment were present in 59% and 23% at baseline, persisting in 59% and 27% at follow-up.Conclusion and RelevanceOrgan impairment was present in 59% of individuals at 6 months post-COVID-19, persisting in 59% of those followed up at 1 year, with implications for symptoms, quality of life and longer-term health, signalling need for prevention and integrated care of Long COVID.Trial RegistrationClinicalTrials.govIdentifier:NCT04369807Key pointsQuestion: What is the prevalence of organ impairment in Long COVID at 6- and 12-months post-COVID-19?Findings: In a prospective study of 536 mainly non-hospitalised individuals, symptom burden decreased, but single organ impairment persisted in 59% at 12 months post-COVID-19.Meaning: Organ impairment in Long COVID has implications for symptoms, quality of life and longer-term health, signalling need for prevention and integrated care of Long COVID.

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The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients

Cited by 4 publications

References 74 publications

Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection

Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection

Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study

Multi-organ impairment and Long COVID: a 1-year prospective, longitudinal cohort study

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