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Article ; Online: Myocardial Inflammation and Dysfunction in COVID-19-Associated Myocardial Injury.

Weckbach, Ludwig T / Curta, Adrian / Bieber, Stephanie / Kraechan, Angelina / Brado, Johannes / Hellmuth, Johannes C / Muenchhoff, Maximilian / Scherer, Clemens / Schroeder, Ines / Irlbeck, Michael / Maurus, Stefan / Ricke, Jens / Klingel, Karin / Kääb, Stefan / Orban, Mathias / Massberg, Steffen / Hausleiter, Jörg / Grabmaier, Ulrich

Circulation. Cardiovascular imaging

2021 Volume 14, Issue 1, Page(s) e012220

Abstract: ... biopsy.: Results: Eighteen patients with COVID-19 and myocardial injury were included in this study ... for COVID-19 using transthoracic echocardiography, cardiac magnetic resonance imaging, and endomyocardial ... Background: Myocardial injury, defined by elevated troponin levels, is associated with adverse ...

Abstract	Background: Myocardial injury, defined by elevated troponin levels, is associated with adverse outcome in patients with coronavirus disease 2019 (COVID-19). The frequency of cardiac injury remains highly uncertain and confounded in current publications; myocarditis is one of several mechanisms that have been proposed. Methods: We prospectively assessed patients with myocardial injury hospitalized for COVID-19 using transthoracic echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy. Results: Eighteen patients with COVID-19 and myocardial injury were included in this study. Echocardiography revealed normal to mildly reduced left ventricular ejection fraction of 52.5% (46.5%-60.5%) but moderately to severely reduced left ventricular global longitudinal strain of -11.2% (-7.6% to -15.1%). Cardiac magnetic resonance showed any myocardial tissue injury defined by elevated T1, extracellular volume, or late gadolinium enhancement with a nonischemic pattern in 16 patients (83.3%). Seven patients (38.9%) demonstrated myocardial edema in addition to tissue injury fulfilling the Lake-Louise criteria for myocarditis. Combining cardiac magnetic resonance with speckle tracking echocardiography demonstrated functional or morphological cardiac changes in 100% of investigated patients. Endomyocardial biopsy was conducted in 5 patients and revealed enhanced macrophage numbers in all 5 patients in addition to lymphocytic myocarditis in 1 patient. SARS-CoV-2 RNA was not detected in any biopsy by quantitative real-time polymerase chain reaction. Finally, follow-up measurements of left ventricular global longitudinal strain revealed significant improvement after a median of 52.0 days (-11.2% [-9.2% to -14.7%] versus -15.6% [-12.5% to -19.6%] at follow-up; Conclusions: In this small cohort of COVID-19 patients with elevated troponin levels, myocardial injury was evidenced by reduced echocardiographic left ventricular strain, myocarditis patterns on cardiac magnetic resonance, and enhanced macrophage numbers but not predominantly lymphocytic myocarditis in endomyocardial biopsies.
MeSH term(s)	Aged ; Biopsy ; COVID-19/blood ; COVID-19/complications ; COVID-19/pathology ; Cohort Studies ; Echocardiography/methods ; Female ; Germany ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Myocarditis/diagnostic imaging ; Myocarditis/etiology ; Myocarditis/pathology ; Myocardium/pathology ; Prospective Studies ; SARS-CoV-2 ; Troponin/blood
Chemical Substances	Troponin
Language	English
Publishing date	2021-01-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2435045-X
ISSN	1942-0080 ; 1941-9651
ISSN (online)	1942-0080
ISSN	1941-9651
DOI	10.1161/CIRCIMAGING.120.011713
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Article ; Online: The Pathogenesis of COVID-19 Myocardial Injury: An Immunohistochemical Study of Postmortem Biopsies.

Hartmann, Camila / Miggiolaro, Anna Flavia Ribeiro Dos Santos / Motta, Jarbas da Silva / Baena Carstens, Lucas / Busatta Vaz De Paula, Caroline / Fagundes Grobe, Sarah / Hermann de Souza Nunes, Larissa / Lenci Marques, Gustavo / Libby, Peter / Zytynski Moura, Lidia / de Noronha, Lucia / Pellegrino Baena, Cristina

Frontiers in immunology

2021 Volume 12, Page(s) 748417

Abstract: Rationale: Myocardial injury associates significantly and independently with mortality in COVID-19 ... for myocardial dysfunction and arrythmias after recovery from the acute phase of COVID-19. ... patients. However, the pathogenesis of myocardial injury in COVID-19 remains unclear, and cardiac ...

Abstract	Rationale: Myocardial injury associates significantly and independently with mortality in COVID-19 patients. However, the pathogenesis of myocardial injury in COVID-19 remains unclear, and cardiac involvement by SARS-CoV-2 presents a major challenge worldwide. Objective: This histological and immunohistochemical study sought to clarify the pathogenesis and propose a mechanism with pathways involved in COVID-19 myocardial injury. Methods and results: Postmortem minimally invasive autopsies were performed in six patients who died from COVID-19, and the myocardium samples were compared to a control group (n=11). Histological analysis was performed using hematoxylin-eosin and toluidine blue staining. Immunohistochemical (IHC) staining was performed using monoclonal antibodies against targets: caspase-1, caspase-9, gasdermin-d, ICAM-1, IL-1β, IL-4, IL-6, CD163, TNF-α, TGF-β, MMP-9, type 1 and type 3 collagen. The samples were also assessed for apoptotic cells by TUNEL. Histological analysis showed severe pericardiocyte interstitial edema and higher mast cells counts per high-power field in all COVID-19 myocardium samples. The IHC analysis showed increased expression of caspase-1, ICAM-1, IL-1β, IL-6, MMP-9, TNF-α, and other markers in the hearts of COVID-19 patients. Expression of caspase-9 did not differ from the controls, while gasdermin-d expression was less. The TUNEL assay was positive in all the COVID-19 samples supporting endothelial apoptosis. Conclusions: The pathogenesis of COVID-19 myocardial injury does not seem to relate to primary myocardiocyte involvement but to local inflammation with associated interstitial edema. We found heightened TGF-β and interstitial collagen expression in COVID-affected hearts, a potential harbinger of chronic myocardial fibrosis. These results suggest a need for continued clinical surveillance of patients for myocardial dysfunction and arrythmias after recovery from the acute phase of COVID-19.
MeSH term(s)	Aged ; Apoptosis ; Biopsy ; COVID-19/metabolism ; COVID-19/pathology ; Caspase 1/metabolism ; Collagen/metabolism ; Cytokines/metabolism ; Female ; Heart Injuries/metabolism ; Heart Injuries/pathology ; Humans ; Immunohistochemistry ; Intercellular Adhesion Molecule-1/metabolism ; Male ; Matrix Metalloproteinase 9/metabolism ; Myocardium/metabolism ; Myocardium/pathology ; SARS-CoV-2
Chemical Substances	Cytokines ; ICAM1 protein, human ; Intercellular Adhesion Molecule-1 (126547-89-5) ; Collagen (9007-34-5) ; Caspase 1 (EC 3.4.22.36) ; MMP9 protein, human (EC 3.4.24.35) ; Matrix Metalloproteinase 9 (EC 3.4.24.35)
Language	English
Publishing date	2021-11-05
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2021.748417
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Article ; Online: The potential role of SARS-CoV-2 infection in acute coronary syndrome and type 2 myocardial infarction (T2MI): Intertwining spread.

Alsaidan, Aseel Awad / Al-Kuraishy, Hayder M / Al-Gareeb, Ali I / Alexiou, Athanasios / Papadakis, Marios / Alsayed, Khalid Adel / Saad, Hebatallah M / Batiha, Gaber El-Saber

Immunity, inflammation and disease

2023 Volume 11, Issue 3, Page(s) e798

Abstract: ... oxidative stress and associated endothelial dysfunction may lead to the development of acute coronary syndrome (ACS ... coronary vessels with atherosclerotic plaques develop minor inflammation during COVID-19 since coronary arteries ... myocarditis. Furthermore, SARS-CoV-2 infection is associated with systemic inflammation that might affect ...

Abstract	Coronavirus disease 2019 (COVID-19) is a novel pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been shown that SARS-CoV-2 infection-induced inflammatory and oxidative stress and associated endothelial dysfunction may lead to the development of acute coronary syndrome (ACS). Therefore, this review aimed to ascertain the link between severe SARS-CoV-2 infection and ACS. ACS is a spectrum of acute myocardial ischemia due to a sudden decrease in coronary blood flow, ranging from unstable angina to myocardial infarction (MI). Primary or type 1 MI (T1MI) is mainly caused by coronary plaque rupture and/or erosion with subsequent occlusive thrombosis. Secondary or type 2 MI (T2MI) is due to cardiac and systemic disorders without acute coronary atherothrombotic disruption. Acute SARS-CoV-2 infection is linked with the development of nonobstructive coronary disorders such as coronary vasospasm, dilated cardiomyopathy, myocardial fibrosis, and myocarditis. Furthermore, SARS-CoV-2 infection is associated with systemic inflammation that might affect coronary atherosclerotic plaque stability through augmentation of cardiac preload and afterload. Nevertheless, major coronary vessels with atherosclerotic plaques develop minor inflammation during COVID-19 since coronary arteries are not initially and primarily targeted by SARS-CoV-2 due to low expression of angiotensin-converting enzyme 2 in coronary vessels. In conclusion, SARS-CoV-2 infection through hypercytokinemia, direct cardiomyocyte injury, and dysregulation of the renin-angiotensin system may aggravate underlying ACS or cause new-onset T2MI. As well, arrhythmias induced by anti-COVID-19 medications could worsen underlying ACS.
MeSH term(s)	Humans ; COVID-19/complications ; Acute Coronary Syndrome/complications ; SARS-CoV-2 ; Myocardial Infarction/complications ; Inflammation ; Plaque, Atherosclerotic/complications
Language	English
Publishing date	2023-03-07
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2740382-8
ISSN	2050-4527 ; 2050-4527
ISSN (online)	2050-4527
ISSN	2050-4527
DOI	10.1002/iid3.798
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Article ; Online: Interleukin-6 is upregulated and may be associated with myocardial injury in some patients who have recovered from COVID-19.

Hayama, Hiromasa / Ide, Satoshi / Kitami, Yui / Hara, Hisao / Kutsuna, Satoshi / Hiroi, Yukio

Global health & medicine

2022 Volume 4, Issue 1, Page(s) 61–63

Abstract: ... is known to be associated with the morbidity and mortality of COVID-19, but this association has not ... Coronavirus disease (COVID-19) causes myocardial injury by inducing a cytokine storm in severe ... cases. Studies have reported that myocardial injury persists for a prolonged period during COVID-19 ...

Abstract	Coronavirus disease (COVID-19) causes myocardial injury by inducing a cytokine storm in severe cases. Studies have reported that myocardial injury persists for a prolonged period during COVID-19 recovery, and cardiac troponin is a useful indicator of myocardial injury. The interleukin-6 (IL-6) level is known to be associated with the morbidity and mortality of COVID-19, but this association has not been studied during recovery. The current study examined the association between IL-6 levels and myocardial damage during COVID-19 recovery. Four of 209 patients (1.9%) who recovered from COVID-19 had elevated IL-6 levels. All 4 patients tested positive for high-sensitivity troponin T, and 3 patients had subclinical left ventricular (LV) dysfunction according to echocardiography. Positivity for IL-6 during COVID-19 recovery suggests ongoing myocardial damage due to inflammation.
Language	English
Publishing date	2022-03-15
Publishing country	Japan
Document type	Journal Article
ISSN	2434-9194
ISSN (online)	2434-9194
DOI	10.35772/ghm.2021.01090
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Article: Acute myocardial injury in patients with COVID-19: Possible mechanisms and clinical implications.

Rusu, Iulia / Turlacu, Malina / Micheu, Miruna Mihaela

World journal of clinical cases

2022 Volume 10, Issue 3, Page(s) 762–776

Abstract: ... of coronavirus infectious disease 2019 (COVID-19) and is associated with a higher risk of severe clinical outcome and ... understanding of the potential mechanisms involved in MI induced by COVID-19 and to discuss the current progress ... increased inflammation, and thrombocyte and endothelial dysfunction, could be involved in acute MI ...

Abstract	Severe acute respiratory syndrome coronavirus 2 infection affects not only the lungs, but also the cardiovascular system, having a major impact on patients' outcomes. Myocardial injury (MI) occurs in the context of coronavirus infectious disease 2019 (COVID-19) and is associated with a higher risk of severe clinical outcome and mortality. COVID-19-related MI can have various clinical manifestations, of which the main ones are myocarditis, stress cardiomyopathy, acute coronary syndrome, and pulmonary embolism. The exact mechanisms of how MI occurs in these patients are not yet fully known. Direct injury, through direct viral myocardial invasion, and indirect injury, through interaction with angiotensin I converting enzyme 2, increased inflammation, and thrombocyte and endothelial dysfunction, could be involved in acute MI in patients with COVID-19. A better understanding of these multiple potential mechanisms may help to develop new targeted therapeutic strategies. The purpose of this review is to provide the current understanding of the potential mechanisms involved in MI induced by COVID-19 and to discuss the current progress in the therapeutic strategies.
Language	English
Publishing date	2022-01-29
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2307-8960
ISSN	2307-8960
DOI	10.12998/wjcc.v10.i3.762
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Article ; Online: Myocardial Injury and Altered Gene Expression Associated With SARS-CoV-2 Infection or mRNA Vaccination.

JACC. Basic to translational science

2022 Volume 8, Issue 2, Page(s) 124–137

Abstract: ... 19 and 6 post-mRNA vaccination patients with myocardial injury and found nearly identical alterations ... in gene expression that would predispose to inflammation, coagulopathy, and myocardial dysfunction. ... myocardial injury or myocarditis can occur during COVID-19 or after mRNA vaccination. We investigated 7 COVID ...

Abstract	SARS CoV-2 enters host cells via its Spike protein moiety binding to the essential cardiac enzyme angiotensin-converting enzyme (ACE) 2, followed by internalization. COVID-19 mRNA vaccines are RNA sequences that are translated into Spike protein, which follows the same ACE2-binding route as the intact virion. In model systems, isolated Spike protein can produce cell damage and altered gene expression, and myocardial injury or myocarditis can occur during COVID-19 or after mRNA vaccination. We investigated 7 COVID-19 and 6 post-mRNA vaccination patients with myocardial injury and found nearly identical alterations in gene expression that would predispose to inflammation, coagulopathy, and myocardial dysfunction.
Language	English
Publishing date	2022-10-19
Publishing country	United States
Document type	Journal Article
ISSN	2452-302X
ISSN (online)	2452-302X
DOI	10.1016/j.jacbts.2022.08.005
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Article ; Online: Emerging Role of Platelet-Endothelium Interactions in the Pathogenesis of Severe SARS-CoV-2 Infection-Associated Myocardial Injury.

Rossouw, Theresa M / Anderson, Ronald / Manga, Pravin / Feldman, Charles

Frontiers in immunology

2022 Volume 13, Page(s) 776861

Abstract: ... focused on the prevalence, risk factors and clinical course of COVID-19-related myocardial injury, as well ... disorders, as part of the acute infection, and that these were associated with more severe disease and ... Cardiovascular dysfunction and disease are common and frequently fatal complications ...

Abstract	Cardiovascular dysfunction and disease are common and frequently fatal complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Indeed, from early on during the SARS-CoV-2 virus pandemic it was recognized that cardiac complications may occur, even in patients with no underlying cardiac disorders, as part of the acute infection, and that these were associated with more severe disease and increased morbidity and mortality. The most common cardiac complication is acute cardiac injury, defined by significant elevation of cardiac troponins. The potential mechanisms of cardiovascular complications include direct viral myocardial injury, systemic inflammation induced by the virus, sepsis, arrhythmia, myocardial oxygen supply-demand mismatch, electrolyte abnormalities, and hypercoagulability. This review is focused on the prevalence, risk factors and clinical course of COVID-19-related myocardial injury, as well as on current data with regard to disease pathogenesis, specifically the interaction of platelets with the vascular endothelium. The latter section includes consideration of the role of SARS-CoV-2 proteins in triggering development of a generalized endotheliitis that, in turn, drives intense activation of platelets. Most prominently, SARS-CoV-2-induced endotheliitis involves interaction of the viral spike protein with endothelial angiotensin-converting enzyme 2 (ACE2) together with alternative mechanisms that involve the nucleocapsid and viroporin. In addition, the mechanisms by which activated platelets intensify endothelial activation and dysfunction, seemingly driven by release of the platelet-derived calcium-binding proteins, SA100A8 and SA100A9, are described. These events create a SARS-CoV-2-driven cycle of intravascular inflammation and coagulation, which contributes significantly to a poor clinical outcome in patients with severe disease.
MeSH term(s)	Angiotensin-Converting Enzyme 2/metabolism ; Blood Platelets/metabolism ; COVID-19/mortality ; COVID-19/pathology ; Cardiovascular Diseases/pathology ; Cardiovascular Diseases/virology ; Coronavirus Nucleocapsid Proteins/immunology ; Endothelial Cells/metabolism ; Endothelium, Vascular/metabolism ; Humans ; Myocardium/pathology ; Phosphoproteins/immunology ; Platelet Activation/immunology ; SARS-CoV-2/immunology ; Spike Glycoprotein, Coronavirus/immunology ; Spike Glycoprotein, Coronavirus/metabolism
Chemical Substances	Coronavirus Nucleocapsid Proteins ; Phosphoproteins ; Spike Glycoprotein, Coronavirus ; nucleocapsid phosphoprotein, SARS-CoV-2 ; spike protein, SARS-CoV-2 ; ACE2 protein, human (EC 3.4.17.23) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23)
Language	English
Publishing date	2022-02-04
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2022.776861
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Article ; Online: “Acute Myocardial Infarction in the Time of COVID-19”

Francesca Gorini / Kyriazoula Chatzianagnostou / Annamaria Mazzone / Elisa Bustaffa / Augusto Esposito / Sergio Berti / Fabrizio Bianchi / Cristina Vassalle

International Journal of Environmental Research and Public Health, Vol 17, Iss 7371, p

A Review of Biological, Environmental, and Psychosocial Contributors

2020 Volume 7371

Abstract: ... COVID-19 has been associated with air pollution, which may also represent an AMI risk factor ... finding. Many possible biological pathways may explain the relationship between COVID-19 and acute ... about all these factors in the complex relationship between COVID-19 and AMI, with particular focus on psychological ...

Abstract	Coronavirus disease 2019 (COVID-19) has quickly become a worldwide health crisis. Although respiratory disease remains the main cause of morbidity and mortality in COVID patients, myocardial damage is a common finding. Many possible biological pathways may explain the relationship between COVID-19 and acute myocardial infarction (AMI). Increased immune and inflammatory responses, and procoagulant profile have characterized COVID patients. All these responses may induce endothelial dysfunction, myocardial injury, plaque instability, and AMI. Disease severity and mortality are increased by cardiovascular comorbidities. Moreover, COVID-19 has been associated with air pollution, which may also represent an AMI risk factor. Nonetheless, a significant reduction in patient admissions following containment initiatives has been observed, including for AMI. The reasons for this phenomenon are largely unknown, although a real decrease in the incidence of cardiac events seems highly improbable. Instead, patients likely may present delayed time from symptoms onset and subsequent referral to emergency departments because of fear of possible in-hospital infection, and as such, may present more complications. Here, we aim to discuss available evidence about all these factors in the complex relationship between COVID-19 and AMI, with particular focus on psychological distress and the need to increase awareness of ischemic symptoms.
Keywords	COVID-19 ; acute myocardial infarction ; cardiovascular risk factors ; inflammation ; pollution ; fear ; Medicine ; R ; covid19
Subject code	610
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Factors associated with myocardial SARS-CoV-2 infection, myocarditis, and cardiac inflammation in patients with COVID-19.

Bearse, Mayara / Hung, Yin P / Krauson, Aram J / Bonanno, Liana / Boyraz, Baris / Harris, Cynthia K / Helland, T Leif / Hilburn, Caroline F / Hutchison, Bailey / Jobbagy, Soma / Marshall, Michael S / Shepherd, Daniel J / Villalba, Julian A / Delfino, Isabela / Mendez-Pena, Javier / Chebib, Ivan / Newton-Cheh, Christopher / Stone, James R

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc

2021 Volume 34, Issue 7, Page(s) 1345–1357

Abstract: COVID-19 has been associated with cardiac injury and dysfunction. While both myocardial ... the relationships between cardiac pathological changes in patients dying from COVID-19 and cardiac infection by SARS ... consecutive autopsies of patients with fatal COVID-19 were analyzed for the associations between cardiac ...

Abstract	COVID-19 has been associated with cardiac injury and dysfunction. While both myocardial inflammatory cell infiltration and myocarditis with myocyte injury have been reported in patients with fatal COVID-19, clinical-pathologic correlations remain limited. The objective was to determine the relationships between cardiac pathological changes in patients dying from COVID-19 and cardiac infection by SARS-CoV-2, laboratory measurements, clinical features, and treatments. In a retrospective study, 41 consecutive autopsies of patients with fatal COVID-19 were analyzed for the associations between cardiac inflammation, myocarditis, cardiac infection by SARS-CoV-2, clinical features, laboratory measurements, and treatments. Cardiac infection was assessed by in situ hybridization and NanoString transcriptomic profiling. Cardiac infection by SARS-CoV-2 was present in 30/41 cases: virus
MeSH term(s)	Aged ; Anticoagulants/therapeutic use ; Autopsy ; COVID-19/blood ; COVID-19/pathology ; Echocardiography ; Electrocardiography ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Myocarditis/pathology ; Myocarditis/virology ; Myocardium/pathology ; Retrospective Studies ; SARS-CoV-2/physiology ; COVID-19 Drug Treatment
Chemical Substances	Anticoagulants ; Immunosuppressive Agents
Language	English
Publishing date	2021-03-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	645073-8
ISSN	1530-0285 ; 0893-3952
ISSN (online)	1530-0285
ISSN	0893-3952
DOI	10.1038/s41379-021-00790-1
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Article ; Online: Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance.

Kotecha, Tushar / Knight, Daniel S / Razvi, Yousuf / Kumar, Kartik / Vimalesvaran, Kavitha / Thornton, George / Patel, Rishi / Chacko, Liza / Brown, James T / Coyle, Clare / Leith, Donald / Shetye, Abhishek / Ariff, Ben / Bell, Robert / Captur, Gabriella / Coleman, Meg / Goldring, James / Gopalan, Deepa / Heightman, Melissa /

European heart journal

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 ... 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 ...

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.
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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