Cardiac involvement in patients recovering from Delta Variant of COVID-19: a prospective multi-parametric MRI study

Abstract

Aims: The cardiac injury and sequelae of Delta Variant of coronavirus disease 2019 (COVID-19) remain unknown. This study aimed to evaluate the presence of cardiac involvement in patients recovering from Delta Variant of COVID-19 based on multi-parametric cardiac magnetic resonance imaging (MRI).

Methods and results: We prospectively assessed patients recovering from Delta Variant of COVID-19 using multi-parametric cardiac magnetic resonance imaging (MRI) between June 2021 and July 2021. Comparison was made with 25 healthy controls. Forty-four patients (median age 51 years, 28 women) recovering from Delta Variant were recruited and had a median time of 35 days between diagnosis and cardiac MRI. There were no patients with chest pain (0/44, 0%) and high sensitivity cardiac troponin T troponin elevation (median levels 2.20 pg/mL, IQR levels 0.85-4.40 pg/mL). Regarding the cardiac imaging findings, a total of 14 (32%) patients presented cardiac tissue feature abnormalities, and a total of 9 (20%) patients had a myocarditis-like injury based on cardiac MRI 2018 Lake Louise criteria. When we further assessed the T1 and T2 mapping values for of patients' individual, abnormal raised global native T1, T2, and extracellular volume were seen in 6 (14%), 6 (14%), and 4 (9%) patients, respectively. Comparing with controls, the patients had lower LV global longitudinal strain and (-22.2 ± 2.8% vs. -24.6 ± 2.0%, P < 0.001) and global circumferential strain (-20.7 ± 6.8% vs. -24.3 ± 2.9%, P = 0.014), but higher global native T1 (1318.8 ± 55.5 ms vs. 1282.9 ± 38.1 ms, P = 0.006). Four (9%) patients presented myocardial late gadolinium enhancement with subepicardial pattern mostly common seen, and two (5%) patients presented pericardial enhancement.

Conclusions: The cardiac MRI could detect subclinical functional and myocardial tissue characteristic abnormalities in individuals who were recovering from Delta Variant without cardiac-related clinical findings. The native T1 mapping and strain imaging may be a sensitive tool for the noninvasive detection of a subset of patients who are at risk for cardiac sequelae and more prone to myocardial damage in survivors with Delta Variant.

Keywords: Delta Variant; T1 mapping; T2 mapping; coronavirus disease 2019; feature tracking.

Figure 1

The flowchart of patient recruitment. COVID‐19, coronavirus disease 2019; MRI, magnetic resonance imaging; LGE, late gadolinium enhancement.

Figure 2

The illustration of all four LGE positive patients' myocardial injury. (A–D) represents cases 1–4, respectively. One short axis and orthogonal long‐axis PSIR images showed focal LGE positive (black arrows) for each patient at the basal‐mid level of the left ventricular in inferior or inferoseptal segments. LGE was most commonly seen in the subepicardial location (A, C, and D). LGE, late gadolinium enhancement; PSIR, phase sensitive inversion recovery.

Figure 3

The illustration of all two LGE positive patients' pericardium injury. (A, B) represents cases 1–2, respectively. Cine images showed pericardial effusion at LV free wall (yellow arrows), and PSIR images showed the corresponded pericardial enhancement (black arrows) for each patient. LV, left ventricular; PSIR, phase sensitive inversion recovery.

Figure 4

The typical images of the multi‐parameter cardiac MRI findings of patients and controls. Top row: Images in a 63‐year‐old female (patient subject) with severe clinical type of Delta Variant, showing negative LGE, elevated global native T1 of 1405.7 ms, elevated ECV of 33.4%, elevated T2 of 57.1 ms, and reduced GLS of −19.0%. In addition, the ECV map (C) and T2 map (D) showed higher ECV (black arrow) and T2 values (white arrow) at the mid‐level of LV in septal segments (ROI 1: ECV = 37.8%, T2 = 60.8 ms) compared with remote normal myocardium (ROI 2: ECV = 29.6%, T2 = 47.1 ms), but the corresponding LGE location was negative; Bottom row: Images in a 57‐year‐old female (control subject) with negative LGE, normal global native T1 (1289.5 ms), normal ECV of 29.8%, normal global T2 (43 ms), and a GLS of −22.7%. ECV, extracellular volume; GLS, global longitudinal strain; LGE, late gadolinium enhancement; PSIR, phase sensitive inversion recovery; SSFP, steady‐state free‐precession.