Related Experiment Video
Updated: Sep 28, 2025
Noninvasive Assessment of Cardiac Abnormalities in Experimental Autoimmune Myocarditis by Magnetic Resonance Microscopy Imaging in the Mouse
Published on: June 20, 2014
Long-Lasting Myocardial and Skeletal Muscle Damage Evidenced by Serial CMR During the First Year in COVID-19 Patients
Laura Filippetti1, Nathalie Pace1, Jean-Sebastien Louis2,3
1Department of Cardiology, CHRU-Nancy, Nancy, France.
Insights
COVID-19 can cause lasting heart damage, with elevated troponin indicating myocardial injury. Serial cardiac MRI revealed persistent extracellular edema in heart and skeletal muscles, which resolved within one year.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- COVID-19 can lead to cardiac complications, including myocardial damage, even in individuals without prior cardiac history.
- Elevated troponin levels in COVID-19 patients suggest myocardial injury, necessitating further investigation into long-term cardiac effects.
- Cardiac Magnetic Resonance (CMR) is a valuable tool for assessing myocardial structure and function.
Purpose of the Study:
- To characterize left-ventricular (LV) damage attributed to COVID-19, distant from the acute phase.
- To investigate persistent myocardial and skeletal muscle abnormalities using serial CMR.
- To monitor LV function and remodeling in the first year post-COVID-19 infection.
Main Methods:
- Observational study of consecutive COVID-19 patients with elevated peak troponin-Ic (> 50 ng/ml) and no prior cardiac disease.
- Serial CMR performed in the early months and at one year after acute infection.
- Assessment of LV function, remodeling, myocardial T1/T2 relaxation times, extracellular volume (ECV), and delayed contrast enhancement.
Main Results:
- At a median of 3.2 months post-troponin peak, 63% of patients showed LV concentric remodeling and 58% had myocardial tissue abnormalities, including increased ECV.
- Increased ECV was also observed in shoulder skeletal muscles (74%) at the first CMR.
- At a median of 11.1 months, 13 patients showed unchanged LV function and remodeling, with resolution of myocardial and skeletal muscle ECV abnormalities.
Conclusions:
- COVID-19-induced myocardial damage, indicated by elevated troponin, can manifest as persistent extracellular edema in the myocardium and skeletal muscles.
- These abnormalities, evident at 3 months, resolved within one year.
- Further large-scale studies are needed to explore the association with long-COVID symptoms.
Introduction:
This observational CMR study aims to characterize left-ventricular (LV) damage, which may be specifically attributed to COVID-19 and is distant in time from the acute phase, through serial CMR performed during the first year in patients with no prior cardiac disease.
Methods:
This study included consecutive patients without any prior history of cardiac disease but with a peak troponin-Ic > 50 ng/ml at the time of the first COVID-wave. All had a CMR in the first months after the acute phase, and some had an additional CMR at the end of the first year to monitor LV function, remodeling, and abnormalities evocative of myositis and myocarditis - i.e., increased T1/T2 relaxation times, increased extracellular volume (ECV), and delayed contrast enhancement.
Results:
Nineteen consecutively admitted COVID-19 patients (17 men, median age 66 [57-71] years) were included. Eight (42%) had hypertension, six (32%) were obese, and 16 (84%) had suffered an acute respiratory distress syndrome. The 1st CMR, recorded at a median 3.2 [interquartile range: 2.6-3.9] months from the troponin peak, showed (1) LV concentric remodeling in 12 patients (63%), (2) myocardial tissue abnormalities in 11 (58%), including 9 increased myocardial ECVs, and (3) 14 (74%) increased ECVs from shoulder skeletal muscles. The 2nd CMR, obtained at 11.1 [11.0-11.7] months from the troponin peak in 13 patients, showed unchanged LV function and remodeling but a return to normal or below the normal range for all ECVs of the myocardium and skeletal muscles.
Conclusion:
Many patients with no history of cardiac disease but for whom an increase in blood troponin-Ic ascertained COVID-19 induced myocardial damage exhibited signs of persistent extracellular edema at a median 3-months from the troponin peak, affecting the myocardium and skeletal muscles, which resolved within a one-year time frame. Associations with long-COVID symptoms need to be investigated on a larger scale now.
Clinical Trial Registration:
NCT04753762 on the ClinicalTrials.gov site.
More Related Videos
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:21Myocarditis I: Introduction
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies