Longitudinal assessment of myocardial involvement in PASC-CVS: a single-center study from China based on...

Persistent cardiac symptoms after COVID-19, termed post-acute sequelae of SARS-CoV-2 infection with cardiovascular involvement (PASC-CVS), remain poorly understood. This study aims to reveal myocardial involvement and long-term cardiac magnetic resonance (CMR) changes in PASC-CVS patients, providing insights into disease progression and recovery.

This prospective single-center study in China enrolled 110 patients with PASC-CVS from March 2023 to April 2024. All participants underwent multiparametric CMR imaging to explore abnormal CMR manifestations in PASC-CVS patients. Clinical symptoms and CMR examinations were collected again one year later. Statistical analysis included the Wilcoxon signed-rank test and logistic regression.

Compared to controls, PASC-CVS patients exhibited significant differences in multiparametric CMR parameters, including Quantification of late gadolinium enhancement (LGE) (%) [odds ratio (OR): 6.36], Global extracellular volume (ECV) (ms) (OR: 1.33), Heart rate (bpm) (OR: 1.08), left ventricular global longitudinal strain (LV GLS) (%) (OR: 1.44), and Global native T1 (ms) (OR: 1.01). The combined multiparametric CMR parameters (Quantification of LGE, Global ECV, Heart rate, LV GLS, Global Post T1, and Global native T1) achieved an area under the curve (AUC) of 0.94, indicating excellent predictive value. At the one-year follow-up (n = 101), significant clinical improvement was observed, with a reduction in PASC scores (a 12-point symptom-based threshold framework) from 14.1 to 5.4 (P < 0.001). Repeat CMR in 20 patients revealed improvements in right ventricular ejection fraction (RV EF) (52.1% to 59.5%, P < 0.001) and global T2 (43.6 ms to 39.5 ms, P < 0.001). However, the proportion of patients showing recovery in Quantification of LGE was 0%, suggesting limited clinical significance of its subtle changes.

Our study reveals myocardial involvement in PASC-CVS patients, with follow-up improvements in RV EF and global T2, underscoring the utility of multiparametric CMR in monitoring and managing PASC-CVS.