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Observation of Myocardial Involvement in Patients Recovered From COVID-19 by Using Cardiac Magnetic Resonance
N Ghafoor1, M M Islam, S N Shakil
1Dr Nusrat Ghafoor, Associate Professor & Consultant, Department of Radiology & Imaging, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh;
Insights
Delayed cardiac involvement is common in COVID-19 survivors with symptoms. Cardiac MRI revealed myocardial edema, fibrosis, and reduced right ventricular function in nearly half of patients, highlighting the need for cardiac monitoring.
Area of Science:
- Cardiology
- Infectious Diseases
- Radiology
Background:
- Previous reports indicate coronavirus can cause myocardial injury in hospitalized patients.
- Delayed cardiac involvement in symptomatic COVID-19 recovery remains understudied.
Purpose of the Study:
- To evaluate cardiac involvement using cardiac magnetic resonance (CMR) in symptomatic patients recovered from COVID-19.
Main Methods:
- Prospective observational study of 30 symptomatic post-COVID-19 patients.
- Utilized a comprehensive CMR scanning protocol including T2-weighted imaging, late gadolinium enhancement (LGE), and quantitative mapping (T1/T2, ECV).
- Assessed myocardial edema, fibrosis, and cardiac function (including right ventricular function).
Main Results:
- Nearly half (46.6%) of patients exhibited abnormal CMR findings.
- Common findings included increased myocardial edema (53.2% of LV segments) and elevated global native T1, T2, and ECV values.
- Reduced right ventricular function was observed in patients with positive CMR findings compared to those with negative findings.
Conclusions:
- Cardiac involvement, including myocardial edema and fibrosis, is present in symptomatic post-COVID-19 recovered patients.
- Reduced right ventricular function is a significant finding in this cohort.
- Symptomatic patients recovering from COVID-19 warrant careful cardiac evaluation.
Abstract:
It was previously reported that coronavirus caused myocardial injury in hospitalized patients. However, delayed cardiac involvement in symptomatic patient recovery from COVID-19 is not yet well known. The objective of this study was to evaluate cardiac involvement by using cardiac magnetic resonance (CMR) in symptomatic post-COVID-19 recovered patients. Thirty (30) patients who recovered from COVID-19 and had recently reported cardiac symptoms were studied in a prospective observational study performed at Popular Medical College Hospital, Dhaka, Bangladesh from March 2021 to September 2021. They underwent CMR examinations. CMR scanning protocol included the following: black blood, cine sequence, both short-axis and long-axis, T2-weight short tau inversion recovery (STIR) sequence, T2- weighted imaging (T2WI) and late gadolinium enhancement (LGE) and quantitative mapping sequences-native T1/T2 mapping and post-contrast T1 mapping. Myocardial edema and late gadolinium enhancement were assessed in all patients. Quantitative evaluation of native T1/T2 and ECV value and cardiac function were evaluated. There were 30 people in all in this study. The average age of the participants in the study was 36.6 years. Fourteen (46.6%) of the patients had abnormal cardiac MRI results, while the remaining 15(53.3%) had negative CMR findings. Among positive findings patients, 8(57.1%) of 14 had increased T2 signal. Increased myocardial edema was found in the same no of patients, involving 53.2% (128 of 224) of LV segments. Only 2 cases (2 of 14) showed mid myocardial and subepicardial LGE, involving 18 of 224, 8.03% of myocardial segments. Global native T1, T2 and ECV values are significantly elevated in all CMR positive findings patients. Native T1 1231ms (IQR: 1281.25-1257.5 versus 1155.5 (IQR: 1137.25-1172.75), T2 40 (IQR: 34.5-43.25) versus 35.5 (IQR: 34-37), ECV 31 (29.75-33.25) versus 23.5 (21.25-24.0), p<0.001; p<0.011 and p<0.001 respectively. Reduced RV functional were found in positive as compared with negative CMR findings patients, EF, 32.05 (IQR: 25.25-39.0) versus 54.5 (IQR: 52.0-57.75) and EDV, 117.5 (IQR: 102.0-134.25) versus 95.0 (IQR: 71.75-99.75), p<0.001 and p<0.001 respectively. In this study cardiac involvement was found in the post-COVID-19 recovered patient with cardiac symptoms. Cardiac MRI findings included myocardial edema, fibrosis and reduced right ventricular function. So attention should be paid to symptomatic post-COVID-19 recovered patients.
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