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Updated: Aug 17, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Cardiac MRI in patients with COVID-19 infection
Emad H Abdeldayem1, Basant M Raief Mosaad2, Aya Yassin2
1Department of Radio-Diagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt. emadhamid30881@yahoo.com.
Objective:
COVID-19 infection is a systemic disease with various cardiovascular symptoms and complications. Cardiac MRI with late gadolinium enhancement is the modality of choice for the assessment of myocardial involvement. T1 and T2 mapping can increase diagnostic accuracy and improve further management. Our study aimed to evaluate the different aspects of myocardial damage in cases of COVID-19 infection using cardiac MRI.
Methods:
This descriptive retrospective study included 86 cases, with a history of COVID-19 infection confirmed by positive RT-PCR, who met the inclusion criteria. Patients had progressive chest pain or dyspnoea with a suspected underlying cardiac cause, either by an abnormal electrocardiogram or elevated troponin levels. Cardiac MRI was performed with late contrast-enhanced (LGE) imaging, followed by T1 and T2 mapping.
Results:
Twenty-four patients have elevated hsTnT with a median hsTnT value of 133 ng/L (IQR: 102 to 159 ng/L); normal value < 14 ng/L. Other sixty-two patients showed elevated hsTnI with a median hsTnI value of 1637 ng/L (IQR: 1340 to 2540 ng/L); normal value < 40 ng/L. CMR showed 52 patients with acute myocarditis, 23 with Takotsubo cardiomyopathy, and 11 with myocardial infarction. Invasive coronary angiography was performed only in selected patients.
Conclusion:
Different COVID-19-related cardiac injuries may cause similar clinical symptoms. Cardiac MRI is the modality of choice to differentiate between the different types of myocardial injury such as Takotsubo cardiomyopathy and infection-related cardiomyopathy or even acute coronary syndrome secondary to vasculitis or oxygen-demand mismatch.
Key Points:
• It is essential to detect early COVID-related cardiac injury using different cardiac biomarkers and cardiac imaging, as it has a significant impact on patient management and outcome. • Cardiac MRI is the modality of choice to differentiate between the different aspects of COVID-related myocardial injury.
Insights
Cardiac MRI effectively identifies diverse myocardial injuries in COVID-19 patients, distinguishing conditions like myocarditis and Takotsubo cardiomyopathy for improved management.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- COVID-19 is a systemic illness with significant cardiovascular implications.
- Cardiac Magnetic Resonance (CMR) imaging, particularly with late gadolinium enhancement (LGE), is crucial for assessing myocardial involvement.
- T1 and T2 mapping sequences enhance diagnostic accuracy in evaluating myocardial damage.
Purpose of the Study:
- To comprehensively evaluate various types of myocardial damage in patients with a history of COVID-19 infection using CMR.
- To assess the utility of CMR in differentiating between different COVID-19-related cardiac injuries.
Main Methods:
- A retrospective descriptive study involving 86 patients with confirmed COVID-19.
- Patients presented with chest pain or dyspnea, and suspected cardiac involvement based on ECG or troponin levels.
- Cardiac MRI was performed, including LGE imaging and T1/T2 mapping sequences.
Main Results:
- Elevated high-sensitivity troponin T (hsTnT) or I (hsTnI) levels were observed in a significant proportion of patients.
- CMR revealed diagnoses including acute myocarditis (52 patients), Takotsubo cardiomyopathy (23 patients), and myocardial infarction (11 patients).
Conclusions:
- COVID-19 can manifest with diverse cardiac injuries presenting with similar clinical symptoms.
- Cardiac MRI is the preferred imaging modality for differentiating between COVID-19-related myocardial injuries like Takotsubo cardiomyopathy, infection-related cardiomyopathy, and acute coronary syndrome.
- Early detection of COVID-related cardiac injury via biomarkers and CMR is vital for patient management and outcomes.
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