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Published on: January 6, 2019
Cardiovascular Magnetic Resonance for Patients With COVID-19
Steffen E Petersen1, Matthias G Friedrich2, Tim Leiner3
1William Harvey Research Institute, National Institute for Health Research Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom.
Insights
Cardiovascular magnetic resonance (CMR) can detect heart abnormalities in patients recovering from COVID-19, including inflammation and functional impairment. This imaging technique is crucial for assessing long-term cardiac health after infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- COVID-19 can cause myocardial injury through ischemia, inflammation, or myocarditis.
- Cardiovascular magnetic resonance (CMR) is the gold standard for assessing cardiac structure and function noninvasively.
- Concerns exist regarding long-term myocardial injury post-COVID-19, with histopathology findings in up to 48% of patients.
Purpose of the Study:
- To review existing studies on CMR use in COVID-19 patients with myocardial injury.
- To present ongoing research evaluating cardiovascular involvement post-COVID-19.
- To provide recommendations for clinical CMR application in acute and recovering COVID-19 patients.
Main Methods:
- Systematic review of published literature on CMR in COVID-19.
- Analysis of studies reporting CMR findings in hospitalized patients and athletes post-COVID-19.
- Inclusion of data on pediatric multisystem inflammatory syndrome and CMR findings.
Main Results:
- CMR abnormalities are reported in 26%–60% of recovered COVID-19 patients.
- Abnormalities include functional impairment, tissue changes, late gadolinium enhancement, and pericardial issues.
- CMR has identified myocarditis-like abnormalities in athletes and aids in evaluating myocarditis/aneurysms in children.
Conclusions:
- CMR is a valuable diagnostic tool for evaluating cardiac dysfunction and injury in COVID-19 patients.
- Long-term myocardial effects of COVID-19 are a concern, necessitating ongoing research with CMR.
- Clinical recommendations for CMR use in COVID-19 patients are being developed based on current evidence.
Abstract:
COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19-related myocarditis is likely infrequent, COVID-19-related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post-COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19-related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.
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