Article ; Online: Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance.
2021 Volume 42, Issue 19, Page(s) 1866–1878
Abstract: ... myocardial injury in recovered COVID-19 patients.: Methods and results: One hundred and forty-eight ... Background: Troponin elevation is common in hospitalized COVID-19 patients, but underlying ... after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered ...
| Abstract | Background: Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients. Methods and results: One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms). Conclusions: During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected. |
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| MeSH term(s) | COVID-19 ; Contrast Media ; Female ; Gadolinium ; Humans ; Magnetic Resonance Imaging, Cine ; Magnetic Resonance Spectroscopy ; Male ; Myocarditis/diagnostic imaging ; Myocardium ; Predictive Value of Tests ; SARS-CoV-2 ; Troponin ; Ventricular Function, Left | ||||||||||
| Chemical Substances | Contrast Media ; Troponin ; Gadolinium (AU0V1LM3JT) | ||||||||||
| Language | English | ||||||||||
| Publishing date | 2021-02-08 | ||||||||||
| Publishing country | England | ||||||||||
| Document type | Journal Article ; Research Support, Non-U.S. Gov't | ||||||||||
| ZDB-ID | 603098-1 | ||||||||||
| ISSN | 1522-9645 ; 0195-668X | ||||||||||
| ISSN (online) | 1522-9645 | ||||||||||
| ISSN | 0195-668X | ||||||||||
| DOI | 10.1093/eurheartj/ehab075 | ||||||||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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