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Updated: Oct 17, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
MRI and CT coronary angiography in survivors of COVID-19
Trisha Singh1,2,3, Thomas A Kite4, Shruti S Joshi5,2
1BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK tsingh@ed.ac.uk.
Insights
COVID-19 survivors show impaired right ventricular function, not left, suggesting pre-existing conditions influence reported myocardial abnormalities. This finding highlights the role of comorbidities in post-COVID cardiac health.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Infectious Diseases
Background:
- Myocardial abnormalities are frequently reported in patients recovering from COVID-19.
- The influence of pre-existing comorbidities on these reported abnormalities requires further investigation.
Purpose of the Study:
- To assess the impact of comorbidities on myocardial abnormalities in patients after COVID-19 infection.
- To evaluate cardiac function and myocardial tissue characteristics using advanced MRI techniques.
Main Methods:
- A prospective, two-centre observational study involving 52 COVID-19 survivors.
- Patients underwent gadolinium and manganese-enhanced MRI and CT coronary angiography (CTCA).
- Comparisons were made with healthy and comorbidity-matched control groups.
Main Results:
- COVID-19 survivors exhibited reduced right ventricular systolic function compared to comorbidity-matched controls.
- Left ventricular function was preserved, and myocardial tissue characteristics (native T1, ECV) were comparable to controls.
- Findings were consistent regardless of COVID-19 severity, myocardial injury, or persistent symptoms.
Conclusions:
- Patients recovering from COVID-19 demonstrate right ventricular dysfunction, but not left ventricular dysfunction.
- Reported left ventricular myocardial abnormalities post-COVID-19 may be attributable to underlying comorbidities.
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.
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