Low Prevalence of Late Myocardial Injury on Cardiac MRI Following COVID-19 Infection
Ady Orbach1, Nilesh R Ghugre1,2,3, Labonny Biswas1
1Schulich Heart Program, Sunnybrook Health Science Center, Toronto, Ontario, Canada.
Background:
The prevalence of abnormal cardiac magnetic resonance imaging (MRI) findings indicative of myocardial injury in patients who recovered from coronavirus disease 2019 (COVID-19) is currently unclear, with a high variability in the reported prevalence.
Purpose:
To assess the prevalence of myocardial injury after a COVID-19 infection.
Study Type:
Prospective, bicentric study.
Subjects:
Seventy consecutive patients who recovered from COVID-19 and were previously hospitalized. Mean age was 57 years and 39% of the patients were female. Ten healthy controls and a comparator group of 75 nonischemic cardiomyopathy (NICM) patients were employed.
Field Strength/Sequence:
1.5-T, steady-state free precession (SSFP) gradient-echo sequence, modified Look-Locker inversion recovery sequence with balanced SSFP readout, T2-prepared spiral readout sequence and a T1-weighted inversion recovery fast gradient-echo sequence was acquired ~4-5 months after recovery from COVID-19.
Assessment:
The SSFP sequence was utilized for the calculation of left and right ventricular volumes and ejection fractions (LVEF and RVEF) following manual endocardial contouring. T1 and T2 mapping was performed by pixel-wise exponential fitting, and T1 and T2 values were computed by manual contouring of the left ventricular endocardial and epicardial walls. Late gadolinium enhancement (LGE) images were graded qualitatively as LGE present or absent.
Statistical Tests:
T-tests and the χ2 or Fisher's exact tests were used to compare continuous and categorical variables respectively between the COVID-19 and NICM groups. Inter-rater agreement was evaluated by the intraclass correlation coefficient for continuous variables and Cohen's kappa test for LGE.
Results:
Reduced RVEF occurred in 10%, LGE and elevated native T1 in 9%, reduced LVEF in 4%, and elevated T2 in 3% of COVID-19 patients, respectively. Patients with NICM had lower mean LVEF (41.6% ± 6% vs. 60% ± 7%), RVEF (46% ± 5% vs. 61% ± 9%), and a significantly higher prevalence of LGE (27% vs. 9%) when compared to those post-COVID-19.
Data Conclusion:
Abnormal cardiac MRI findings may show a low prevalence in patients who recovered from COVID-19 and were previously hospitalized.
Level Of Evidence:
2 TECHNICAL EFFICACY: Stage 2.
Insights
Cardiac MRI studies reveal a low prevalence of myocardial injury in patients after COVID-19 recovery. These findings suggest that significant heart damage is uncommon following coronavirus disease 2019 (COVID-19) infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- The prevalence of cardiac magnetic resonance imaging (MRI) findings indicating myocardial injury post-coronavirus disease 2019 (COVID-19) recovery remains uncertain.
- Previous reports show high variability in the prevalence of such findings.
Purpose of the Study:
- To determine the prevalence of myocardial injury in patients following COVID-19 infection using cardiac MRI.
- To assess cardiac function and myocardial tissue characteristics after COVID-19.
Main Methods:
- A prospective, bicentric study involving 70 COVID-19 recovered patients, 10 healthy controls, and 75 nonischemic cardiomyopathy patients.
- Cardiac MRI sequences including steady-state free precession (SSFP), T1/T2 mapping, and late gadolinium enhancement (LGE) were acquired approximately 4-5 months post-infection.
- Analysis included ventricular volumes, ejection fractions, T1/T2 values, and LGE assessment, with statistical comparisons between groups.
Main Results:
- Reduced right ventricular ejection fraction (RVEF) was observed in 10% of COVID-19 patients, while elevated native T1 and LGE were present in 9%.
- Reduced left ventricular ejection fraction (LVEF) occurred in 4%, and elevated T2 in 3% of post-COVID-19 patients.
- Nonischemic cardiomyopathy patients exhibited significantly lower LVEF and RVEF, and a higher prevalence of LGE compared to the COVID-19 group.
Conclusions:
- Abnormal cardiac MRI findings indicative of myocardial injury appear to have a low prevalence in patients hospitalized and recovered from COVID-19.
- The study suggests that significant cardiac damage is not a common long-term consequence of COVID-19 hospitalization.
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