Abnormal cardiac MRI findings after COVID-19 may signal myocardial damage
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Cardiac MRI revealed that among patients who recovered from COVID-19, 78% experienced myocardial inflammation, regional scar or pericardial enhancement, according to findings published in JAMA Cardiology.
These patients had no prior history HF or cardiomyopathy.
“To our knowledge, this is the first prospective report on a cohort of unselected patients with a recent COVID-19 infection identified from a local testing center who voluntarily underwent evaluation for cardiac involvement with [cardiac MRI],” Valentina O. Puntmann, MD, PhD, of the Institute for Experimental and Translational Cardiovascular Imaging at the German Center for Cardiovascular Research and the Center for Cardiovascular Imaging at the University Hospital Frankfurt, Germany, and colleagues wrote. “The results of our study provide important insights into the prevalence of cardiovascular involvement in the early convalescent stage.”
Researchers accessed demographic characteristics, cardiac blood markers and cardiac MRI findings of 100 patients from Germany (53% men; median age, 49 years) who recently recovered from COVID-19 to identify any evidence of myocardial injury. Patients underwent cardiac MRI a median of 71 days after initial COVID-19 diagnosis.
Among the cohort, 67% recovered at home while 33% required hospitalization.
Investigators measured high-sensitivity troponin levels of 3 pg/mL or greater in 71% of the cohort, and levels of 13.9 pg/mL or greater in 5% of participants.
Overall, 78% of the cohort presented with abnormal cardiac MRI findings that included raised myocardial native T1 (73%), raised myocardial native T2 (60%), myocardial late gadolinium enhancement (32%) and pericardial enhancement (22%).
Researchers observed slightly lower native T1 values among patients who recovered from COVID-19 at home compared with those who were hospitalized (1,122 ms vs. 1,143 ms; P = .02). The association was not significant for native T2, high-sensitivity troponin or N-terminal pro-B-type natriuretic peptide.
“Our findings demonstrate that participants with a relative paucity of preexisting cardiovascular condition and with mostly home-based recovery had frequent cardiac inflammatory involvement, which was similar to the hospitalized subgroup with regards to severity and extent,” the researchers wrote.
In other findings, high-sensitivity troponin was associated with native T1 (r = 0.35; P < .001) and native T2 (r = 0.22; P = .03).
Researchers also observed a significant association between high-sensitivity troponin with native T1 (r = 0.35; P < .001) and left ventricle mass (r = 0.32; P < .001).
“Each of the abnormal imaging parameters can be linked to an underlying pathophysiological process and worse outcome,” the researchers wrote. “The periepicardial late gadolinium enhancement in the areas with increased contrast agent uptake represents regional damage due to myocardial inflammation. Especially in combination with pericardial effusion, these observations can be attributed to fibrosis and/or edema due to an ongoing active pericarditis.”
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