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MRI of cardiac involvement in COVID-19
Moezedin Javad Rafiee1,2, Matthias G Friedrich1,2
1Department of Medicine, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada.
Insights
COVID-19 can cause significant heart damage, including myocarditis, increasing mortality risk. Cardiovascular Magnetic Resonance (CMR) is vital for diagnosing these myocardial injuries and guiding patient management.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- The COVID-19 pandemic, caused by SARS-CoV-2, has been linked to diverse myocardial injuries, including myocarditis, associated with poor patient outcomes.
- Myocardial injury in severe COVID-19 patients correlates with significantly higher mortality rates.
- Cardiovascular Magnetic Resonance (CMR) is a key diagnostic modality for assessing myocardial damage.
Purpose of the Study:
- To review histopathological findings and CMR imaging patterns of myocardial injuries in COVID-19 patients.
- To synthesize current research on the cardiac impact of COVID-19.
- To highlight the utility of CMR in diagnosing and managing COVID-19 related cardiac complications.
Main Methods:
- Systematic review of existing studies on histopathology and CMR imaging in COVID-19 patients.
- Analysis of CMR findings, including inflammation, edema, fibrosis, and ischemic injury.
- Evaluation of diagnostic criteria (e.g., LLC criteria) for COVID-related myocarditis.
Main Results:
- CMR reveals complex cardiac damage in COVID-19, such as inflammation, edema, fibrosis, and microthrombi-induced ischemic injury.
- Myocardial injury is a significant predictor of mortality in hospitalized COVID-19 patients.
- CMR effectively detects cardiac complications in specific populations like children with MIS-C and athletes.
Conclusions:
- CMR is essential for diagnosing and characterizing myocardial injuries in COVID-19.
- Understanding CMR patterns aids in managing cardiac complications and improving prognosis for COVID-19 patients.
- CMR plays a crucial role in assessing myocardial injury post-infection and post-vaccination.
Abstract:
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to a diverse pattern of myocardial injuries, including myocarditis, which is linked to adverse outcomes in patients. Research indicates that myocardial injury is associated with higher mortality in hospitalized severe COVID-19 patients (75.8% vs 9.7%). Cardiovascular Magnetic Resonance (CMR) has emerged as a crucial tool in diagnosing both ischaemic and non-ischaemic myocardial injuries, providing detailed insights into the impact of COVID-19 on myocardial tissue and function. This review synthesizes existing studies on the histopathological findings and CMR imaging patterns of myocardial injuries in COVID-19 patients. CMR imaging has revealed a complex pattern of cardiac damage in these patients, including myocardial inflammation, oedema, fibrosis, and ischaemic injury, due to coronary microthrombi. This review also highlights the role of LLC criteria in diagnosis of COVID-related myocarditis and the importance of CMR in detecting cardiac complications of COVID-19 in specific groups, such as children, manifesting multisystem inflammatory syndrome in children (MIS-C) and athletes, as well as myocardial injuries post-COVID-19 infection or following COVID-19 vaccination. By summarizing existing studies on CMR in COVID-19 patients and highlighting ongoing research, this review contributes to a deeper understanding of the cardiac impacts of COVID-19. It emphasizes the effectiveness of CMR in assessing a broad spectrum of myocardial injuries, thereby enhancing the management and prognosis of patients with COVID-19 related cardiac complications.
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