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Cardiovascular magnetic resonance imaging and spectroscopy in clinical long-COVID-19 syndrome: a prospective
Miroslawa Gorecka1, Nicholas Jex1, Sharmaine Thirunavukarasu1
1Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
Insights
Long COVID-19 syndrome did not show cardiac abnormalities in patients without prior cardiovascular disease. Cardiovascular magnetic resonance imaging found no differences in myocardial structure, function, or energy metabolism compared to healthy controls.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Long COVID Research
Background:
- Pathophysiology of long COVID-19 syndrome is unknown, with potential roles for increased cardiometabolic demand and mitochondrial dysfunction.
- Cardiovascular magnetic resonance (CMR) and 31-phosphorus CMR spectroscopy (31P-CMRS) assess myocardial energetics and cardiovascular disease mechanisms.
Purpose of the Study:
- To investigate if long COVID-19 syndrome is associated with abnormalities in myocardial structure, function, perfusion, and energy metabolism.
- To compare cardiac parameters in long COVID-19 patients without prior cardiovascular disease against healthy controls.
Main Methods:
- Prospective case-control study involving 20 long COVID-19 patients and 10 healthy controls.
- Utilized 3T Cardiovascular Magnetic Resonance (CMR) and 31-phosphorus CMR spectroscopy (31P-CMRS) for comprehensive cardiac assessment.
- Included assessment of myocardial energetics, structure, function, tissue characterization, and perfusion.
Main Results:
- No significant differences were observed in myocardial energetics (phosphocreatine to ATP ratio) between long COVID-19 patients and controls.
- Cardiac structure, function (ejection fraction, global longitudinal strain), tissue characteristics (T1 mapping, late gadolinium enhancement), and perfusion (myocardial blood flow, reserve) were comparable.
- One long COVID-19 patient had imaging findings suggestive of prior myocarditis, but without associated cardiac abnormalities.
Conclusions:
- The majority of long COVID-19 patients without prior cardiovascular disease showed no cardiac abnormalities on CMR and 31P-CMRS.
- Findings suggest that significant myocardial structural, functional, or energetic deficits are uncommon in this cohort of long COVID-19 patients.
Background:
The underlying pathophysiology of post-coronavirus disease 2019 (long-COVID-19) syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus CMR spectroscopy (31P-CMRS) allows non-invasive assessment of the myocardial energetic state. The main aim of the study was to assess whether long COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and energy metabolism.
Methods:
Prospective case-control study. A total of 20 patients with a clinical diagnosis of long COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and 10 matching healthy controls underwent 31P-CMRS and CMR at 3T at a single time point. All patients had been symptomatic with acute COVID-19, but none required hospital admission.
Results:
Between the long COVID-19 syndrome patients and matched contemporary healthy controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T1 mapping and late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with long COVID-19 syndrome showed subepicardial hyperenhancement on late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, extracellular volume fraction, native T1, T2 or cardiac energetics.
Conclusions:
In this prospective case-control study, the overwhelming majority of patients with a clinical long COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics.
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