Abstract
Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and are associated with high mortality rates. Moreover, positive SARS-CoV-2 patients with underlying cardiovascular disease are more likely to require intensive care and are at higher risk of death. The underlying mechanism for myocardial injury is multifaceted, in which the severe inflammatory response causes myocardial inflammation, coronary plaque destabilization, acute thrombotic events, and ischemia. Cardiac magnetic resonance (CMR) imaging is the non-invasive method of choice for identifying myocardial injury, and it is able to differentiate between underlying causes in various and often challenging clinical scenarios. Multimodal imaging protocols that incorporate CMR and computed tomography provide a complex evaluation for both respiratory and cardiovascular complications of SARS-CoV2 infection. This, in relation to biological evaluation of systemic inflammation, can guide appropriate therapeutic management in every stage of the disease. The use of artificial intelligence can further improve the diagnostic accuracy of these imaging techniques, thus enabling risk stratification and evaluation of prognosis. The present manuscript aims to review the current knowledge on the possible modalities for imaging COVID-related myocardial inflammation or post-COVID coronary inflammation and atherosclerosis.
Highlights
Accepted: 15 June 2021The coronavirus disease 2019 (COVID-19) outbreak laid an unparalleled burden on healthcare systems worldwide
Current data show that 20–40% of COVID-19 patients present clinical signs or laboratory biomarkers of myocardial injury, predominantly in those who are treated in intensive care units with an associated poorer prognosis [22]
Recent systematic reviews evidenced that the presence of takotsubo cardiomyopathy in COVID-19 patients was associated with high complication rates (54–80%), irrespective of cardiac comorbidities and was more frequent in older female patients [51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]
Summary
The coronavirus disease 2019 (COVID-19) outbreak laid an unparalleled burden on healthcare systems worldwide. The first published data have shown worse outcomes, higher incidence of complications and requirement of intensive care in patients with underlying cardiovascular disease and a five-to-tenfold increase in mortality rates [2]. In the context of COVID-19 pandemic, cardiac magnetic resonance should be the method of choice for investigating myocardial involvement while CTA should be used to assess coronary atherosclerosis and inflammation-mediated coronary plaque vulnerabilization. Despite their relevant contribution to diagnose cardiac involvement, COVID complications or post-COVID cardiovascular risk, these are still underused diagnostic tools. The present manuscript aims to review the current knowledge on the possible modalities for imaging COVID-related myocardial inflammation or post-COVID coronary inflammation and atherosclerosis
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