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Non-Ischemic Pattern of LGE After COVID-19 Correlates More with Severity of Acute Illness than with Long-Term

Alessandro Pingitore1,2, Filippo Figini2, Laura Pederzoli2

  • 1Clinical Physiology Institute, Counsil National Research (CNR), 56124 Pisa, Italy.

Journal of Clinical Medicine
|November 13, 2025
PubMed

Insights

Late gadolinium enhancement (LGE) in COVID-19 patients did not impact cardiac function or structure. This non-ischemic pattern was linked to longer hospital stays, suggesting a residual scar with minimal prognostic significance.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Radiology

Background:

  • Myocarditis is a potential complication of coronavirus disease 2019 (COVID-19).
  • Non-ischemic late gadolinium enhancement (LGE) may indicate active myocardial involvement or sequelae of myocarditis.
  • Assessing LGE effects on cardiac function and morphology in severe COVID-19 is crucial.

Purpose of the Study:

  • To evaluate the impact of non-ischemic LGE on cardiac function and morphology.
  • To identify factors associated with LGE in COVID-19 patients admitted to the ICU.

Main Methods:

  • Cardiac magnetic resonance (CMR) imaging was used to assess LGE.
  • Fifty patients with COVID-19-related acute respiratory distress syndrome were enrolled.
  • Analysis compared cardiac variables between patients with and without LGE.

Main Results:

  • The prevalence of LGE was 33.3% in the study population.
  • LGE was predominantly found in the lateral wall and interventricular septum.
  • No significant differences in cardiac magnetic resonance imaging (CMR) variables were observed between groups, except for one case of regional wall motion abnormality.
  • Longer hospitalization duration was significantly associated with the presence of LGE (p = 0.007).

Conclusions:

  • Non-ischemic LGE patterns were not associated with left ventricular dilatation, dysfunction, or remodeling in severe COVID-19.
  • LGE presence correlated with prolonged hospitalization, suggesting it may represent a residual myocardial scar.
  • Further multicenter studies are needed to confirm the limited prognostic impact of LGE in COVID-19.

Keywords:
COVID-19cardiac magnetic resonancelate gadolinium enhancementmyocarditis

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