MRI and CT coronary angiography in survivors of COVID-19

Abstract

Objectives: To determine the contribution of comorbidities on the reported widespread myocardial abnormalities in patients with recent COVID-19.

Methods: In a prospective two-centre observational study, patients hospitalised with confirmed COVID-19 underwent gadolinium and manganese-enhanced MRI and CT coronary angiography (CTCA). They were compared with healthy and comorbidity-matched volunteers after blinded analysis.

Results: In 52 patients (median age: 54 (IQR 51-57) years, 39 males) who recovered from COVID-19, one-third (n=15, 29%) were admitted to intensive care and a fifth (n=11, 21%) were ventilated. Twenty-three patients underwent CTCA, with one-third having underlying coronary artery disease (n=8, 35%). Compared with younger healthy volunteers (n=10), patients demonstrated reduced left (ejection fraction (EF): 57.4±11.1 (95% CI 54.0 to 60.1) versus 66.3±5 (95 CI 62.4 to 69.8)%; p=0.02) and right (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 60.5±4.9 (95% CI 57.1 to 63.2)%; p≤0.0001) ventricular systolic function with elevated native T1 values (1225±46 (95% CI 1205 to 1240) vs 1197±30 (95% CI 1178 to 1216) ms;p=0.04) and extracellular volume fraction (ECV) (31±4 (95% CI 29.6 to 32.1) vs 24±3 (95% CI 22.4 to 26.4)%; p<0.0003) but reduced myocardial manganese uptake (6.9±0.9 (95% CI 6.5 to 7.3) vs 7.9±1.2 (95% CI 7.4 to 8.5) mL/100 g/min; p=0.01). Compared with comorbidity-matched volunteers (n=26), patients had preserved left ventricular function but reduced right ventricular systolic function (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 59.3±4.9 (95% CI 51.0 to 66.5)%; p=0.0005) with comparable native T1 values (1225±46 (95% CI 1205 to 1240) vs 1227±51 (95% CI 1208 to 1246) ms; p=0.99), ECV (31±4 (95% CI 29.6 to 32.1) vs 29±5 (95% CI 27.0 to 31.2)%; p=0.35), presence of late gadolinium enhancement and manganese uptake. These findings remained irrespective of COVID-19 disease severity, presence of myocardial injury or ongoing symptoms.

Conclusions: Patients demonstrate right but not left ventricular dysfunction. Previous reports of left ventricular myocardial abnormalities following COVID-19 may reflect pre-existing comorbidities.

Trial registration number: NCT04625075.

Keywords: COVID-19; magnetic resonance imaging.

Figure 1

CONSORT diagram. CONSORT, Consolidated Standards of Reporting Trials; CTCA, CT coronary angiography; ECMO, extracorporeal membrane oxygenation; PIL, patient information leaflet.

Figure 2

Chest CT in severe COVID-19. Typical COVID-19 appearance with ground glass opacification (long arrow) and peripheral basal consolidation (short arrow) on during hospital admission (A) and 4 months later (B) with residual atelectasis (short arrow) and subtle ground glass opacification (long arrow) in a patient with severe COVID-19 with ongoing symptoms compared with a patient with COVID-19 without symptoms (C).

Figure 3

Cardiac MRI in patients with COVID-19 compared with matched volunteers and healthy volunteers. Left ventricular (LV) ejection fraction (A), right ventricular (RV) ejection fraction (B), native T1 values (C) and extracellular volume (D) in healthy control volunteers (n=10, green), matched control volunteers (n=26, blue) and patients with COVID-19 (n=52, red).

Figure 4

Cardiac magnetic resonance features in hospitalised COVID-19 survivors. MRI findings in patients recovering from COVID-19 infection compared with age, sex and comorbidity matched volunteers. *Statistically significant.

Figure 5

Cardiac MRI in subgroups of atients with COVID-19 compared with matched volunteers. Left ventricular (LV) ejection fraction (A), right ventricular (RV) ejection fraction (B), native T1 values (C) and extracellular volume (D) in matched control volunteers (n=26, green) and patients with COVID-19 and severe COVID-19 disease (n=27, red), myocardial injury (n=17, orange) or ongoing symptoms (n=20, blue).