Absence of long-term structural and functional cardiac abnormalities on multimodality imaging in a multi-ethnic group of COVID-19 survivors from the early stage of the pandemic

Abstract

Aims: Many patients with coronavirus disease-2019 (COVID-19), particularly from the pandemic's early phase, have been reported to have evidence of cardiac injury such as cardiac symptoms, troponinaemia, or imaging or ECG abnormalities during their acute course. Cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) have been widely used to assess cardiac function and structure and characterize myocardial tissue during COVID-19 with report of numerous abnormalities. Overall, findings have varied, and long-term impact of COVID-19 on the heart needs further elucidation.

Methods and results: We performed TTE and 3 T CMR in survivors of the initial stage of the pandemic without pre-existing cardiac disease and matched controls at long-term follow-up a median of 308 days after initial infection. Study population consisted of 40 COVID-19 survivors (50% female, 28% Black, and 48% Hispanic) and 12 controls of similar age, sex, and race-ethnicity distribution; 35% had been hospitalized with 28% intubated. We found no difference in echocardiographic characteristics including measures of left and right ventricular structure and systolic function, valvular abnormalities, or diastolic function. Using CMR, we also found no differences in measures of left and right ventricular structure and function and additionally found no significant differences in parameters of tissue structure including T1, T2, extracellular volume mapping, and late gadolinium enhancement. With analysis stratified by patient hospitalization status as an indicator of COVID-19 severity, no differences were uncovered.

Conclusion: Multimodal imaging of a diverse cohort of COVID-19 survivors indicated no long-lasting damage or inflammation of the myocardium.

Keywords: COVID-19; cardiac inflammation; cardiac magnetic resonance; multimodality imaging; transthoracic echocardiography.

Graphical abstract

Figure 1

Late gadolinium in cardiac magnetic resonance imaging scan of COVID-19 patient. Late gadolinium in the basal inferior wall in the only patient in the cohort with enhancement at 10 months post-hospitalization and intubation for COVID-19 This scan was performed using a 3T GE SIGNA™ Premier scanner with late gadolinium enhancement with phase-sensitive inversion recovery, obtained 10 min after administration of gadoterate meglumine (Clariscan, GE Healthcare). Arrow points to LGE.

Figure 2

Violin plots of transthoracic echocardiogram characteristics of COVID-19 patients vs. controls. Distribution of key echocardiographic characteristics between cases (1, blue) and controls (2, red) including LVEF, left ventricular ejection fraction; LVEDVi, left ventricular end diastolic volume index; LVMi, left ventricular mass index; IVS, interventricular septum thickness; RVS, right ventricular S; RVSP, right ventricular systolic pressure; E to E′, E to Eprime; S′, Sprime. These violin plots show data points within the outline of the distribution of the data plotted vertically.

Figure 3

Violin plots of cardiac magnetic resonance characteristics of COVID-19 patients vs. controls. Distribution of key CMR characteristics between cases (1, blue) and controls (2, red) including LVEF (left ventricular ejection fraction), LVEDVi (left ventricular end diastolic volume index), LVMi (left ventricular mass index), RVEF (right ventricular ejection fraction), RVEDVi (right ventricular end diastolic volume index), T1, T2, and extracellular volume fraction.