Abstract
BackgroundCoronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic inflammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiovascular magnetic resonance (CMR). However, the middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMRMethodsA total of 47 recovered COVID-19 patients were prospectively recruited and underwent CMR examination. The CMR protocol consisted of black blood fat-suppressed T2 weighted imaging, T2 star mapping, left ventricle (LV) cine imaging, pre- and post-contrast T1 mapping, and late gadolinium enhancement (LGE). LGE were assessed in mixed both recovered COVID-19 patients and healthy controls. The LV and right ventricle (RV) function and LV mass were assessed and compared with healthy controls.ResultsA total of 44 recovered COVID-19 patients and 31 healthy controls were studied. LGE was found in 13 (30%) of COVID-19 patients. All LGE lesions were located in the mid myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had significantly decreased LV peak global circumferential strain (GCS), RV peak GCS, RV peak global longitudinal strain (GLS) as compared to non-LGE patients (p < 0.05), while no difference was found between the non-LGE patients and healthy controls.ConclusionMyocardium injury existed in 30% of COVID-19 patients. These patients have depressed LV GCS and peak RV strains at the 3-month follow-up. CMR can monitor the COVID-19-induced myocarditis progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of LV and RV dysfunction.
Highlights
Coronavirus disease 2019 (COVID-19) is a nascent pandemic
Population characteristics From May 8 to July 20, 2020, 47 patients who recovered from COVID-19 were recruited and underwent cardiovascular magnetic resonance (CMR)
Among the 31 normal controls, 19 were male, which matched with the COVID-19 group
Summary
Coronavirus disease 2019 (COVID-19) is a nascent pandemic. Until July 20, 2020, 14,353,494 confirmed cases, including 603,703 deaths, were reported to the World Health Organization [1]. A recent single-center study from Wuhan demonstrated that more than half of the recovered COVID-19 patients sustain cardiac edema, fibrosis, and impaired right ventricle (RV) contractile function [11]. In this small-sample retrospective study, only patients with reported cardiac symptoms were included. The middle-term outcome of cardiac involvement in COVID-19 patients is yet unknown. Coronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic inflammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiovascular magnetic resonance (CMR). The middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMR
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