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. 2021 Feb 25;23(1):14.
doi: 10.1186/s12968-021-00710-x.

Cardiac involvement in COVID-19 patients: mid-term follow up by cardiovascular magnetic resonance

Hui Wang #  1 , Ruili Li #  2 , Zhen Zhou  1 , Hong Jiang  1 , Zixu Yan  1 , Xinyan Tao  1 , Hongjun Li  3 , Lei Xu  4
Affiliations

Cardiac involvement in COVID-19 patients: mid-term follow up by cardiovascular magnetic resonance

Hui Wang et al. J Cardiovasc Magn Reson. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic inflammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiovascular magnetic resonance (CMR). However, the middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMR METHODS: A total of 47 recovered COVID-19 patients were prospectively recruited and underwent CMR examination. The CMR protocol consisted of black blood fat-suppressed T2 weighted imaging, T2 star mapping, left ventricle (LV) cine imaging, pre- and post-contrast T1 mapping, and late gadolinium enhancement (LGE). LGE were assessed in mixed both recovered COVID-19 patients and healthy controls. The LV and right ventricle (RV) function and LV mass were assessed and compared with healthy controls.

Results: A total of 44 recovered COVID-19 patients and 31 healthy controls were studied. LGE was found in 13 (30%) of COVID-19 patients. All LGE lesions were located in the mid myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had significantly decreased LV peak global circumferential strain (GCS), RV peak GCS, RV peak global longitudinal strain (GLS) as compared to non-LGE patients (p < 0.05), while no difference was found between the non-LGE patients and healthy controls.

Conclusion: Myocardium injury existed in 30% of COVID-19 patients. These patients have depressed LV GCS and peak RV strains at the 3-month follow-up. CMR can monitor the COVID-19-induced myocarditis progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of LV and RV dysfunction.

Keywords: COVID-19; Cardiac dysfunction; Cardiac involvement; Cardiac magnetic resonance imaging.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Illustration of all13 late gadolinium enhancement (LGE) positvie patients’ myocardial injury. a–m represents case 1–13, respectively. One short axis and orthogonal long-axis phase sensitive inversion recovery (PSIR) images show LGE (arrow) for each patient. PSIR phase-sensitive inversion recovery, LGE late gadolinium enhancement
Fig. 1
Fig. 1
Illustration of all13 late gadolinium enhancement (LGE) positvie patients’ myocardial injury. a–m represents case 1–13, respectively. One short axis and orthogonal long-axis phase sensitive inversion recovery (PSIR) images show LGE (arrow) for each patient. PSIR phase-sensitive inversion recovery, LGE late gadolinium enhancement
Fig. 1
Fig. 1
Illustration of all13 late gadolinium enhancement (LGE) positvie patients’ myocardial injury. a–m represents case 1–13, respectively. One short axis and orthogonal long-axis phase sensitive inversion recovery (PSIR) images show LGE (arrow) for each patient. PSIR phase-sensitive inversion recovery, LGE late gadolinium enhancement
Fig. 1
Fig. 1
Illustration of all13 late gadolinium enhancement (LGE) positvie patients’ myocardial injury. a–m represents case 1–13, respectively. One short axis and orthogonal long-axis phase sensitive inversion recovery (PSIR) images show LGE (arrow) for each patient. PSIR phase-sensitive inversion recovery, LGE late gadolinium enhancement
Fig. 2
Fig. 2
Dominant distribution of myocardial LGE segments in recovered COVID-19 patients. Number of myocardial LGE distributed in American Heart Association 16 segment model in all the 13 patients
See this image and copyright information in PMC

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