Abstract
Myocardial injury is a common complication of the COVID-19 illness and is associated with a worsened prognosis. Systemic hyperinflammation seen in the advanced stage of COVID-19 likely contributes to myocardial injury. Cardiac magnetic resonance imaging (CMR) is the preferred imaging modality for non-invasive evaluation in acute myocarditis, enabling risk stratification and prognostication. Modified scanning protocols in the pandemic setting reduce risk of exposure while providing critical data regarding cardiac tissue inflammation and fibrosis, chamber remodeling, and contractile function. The growing use of CMR in clinical practice to assess myocardial injury will improve understanding of the acute and chronic sequelae of myocardial inflammation from various pathological etiologies.
Highlights
Myocardial Injury in COVID-19: The worldwide coronavirus disease2019 (COVID-19) pandemic has overwhelmed healthcare systems across the world since the outbreak began in Wuhan, China, in December 2019
Myocardial injury is a common complication of the COVID-19 illness and is associated with a worsened prognosis
Dynamic ECG changes, and echocardiographic findings of ventricular dysfunction are associated with myocardial injury, Cardiac MRI (CMR) is the preferred imaging modality for noninvasive evaluation in acute myocarditis per the AHA and European Society of Cardiology (ESC) guidelines [2,32,33,34,35,36]
Summary
Myocardial Injury in COVID-19: The worldwide coronavirus disease2019 (COVID-19) pandemic has overwhelmed healthcare systems across the world since the outbreak began in Wuhan, China, in December 2019. Myocardial injury as evidenced by clinical, laboratory, and diagnostic evaluation has been observed in the advanced stages of the COVID-19 infection. Cardiac MRI (CMR) has evolved to become the preferred imaging modality for noninvasive evaluation in acute myocarditis [2,3], as pathognomonic features of myocardial inflammation can be identified with improved sensitivity and specificity [4]. Signal intensities used to see pathophysiologic changes from edemas and hyperemia to fibrosis are coupled with quantitative parametric mapping of T1 and T2 relaxation times to improve diagnostic accuracy and identify both acute and chronic changes of myocardial inflammation. Tissue characterization with CMR is critical to evaluating prognosis in the acute and chronic phases of the myocardial and systemic disease course [4,5].
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