Impact of Covid-19 and pandemic restrictions on post infarction myocardial scar evaluated on cardiac magnetic resonance

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Italy was one of the first nations in the world to face the threat of COVID-19. Data suggest that mortality from cardiovascular causes increased during the pandemic period, compared with a reduction of the number of hospitalizations for the same cause1–2. Purpose Extension of myocardial damage after a cardiac ischemic event is strongly related to patient's short- and long-term prognosis. Aim of this retrospective study is to evaluate the impact of COVID-19 and pandemic restrictions on the extension of the post-infarct myocardial scar, assessed by cardiac magnetic resonance imaging. Methods Fifty consecutive patients hospitalized for acute myocardial infarction who underwent CMR were retrospectively enrolled: 30 patients in the pre-COVID period (from January 2015 to February 2020) and 20 in the pandemic period (from March 2020 to June 2021). We selected only patients with no previous history of ischemic heart disease. Clinical, anamnestic and imaging data (echocardiography and cardiac magnetic resonance) were collected. Results Patients of the two groups did not differ in clinical characteristics, except for the absence of women in the pandemic group (23% vs 0%, p = 0.02). Drugs and treatments used, severity of coronary artery disease and echocardiographic parameters were similar in both groups. The number of segments with transmural fibrosis was larger in COVID group (5.9 vs 4.2, p = 0.05, considering 17 myocardial segments on a bull eyes map). Furthermore in COVID group end diastolic volume was larger (101.3 vs 86.9 ml/mq, p = 0.08) and left ejection fraction was lower (36.0 vs 41.4%, p = 0.18), although not statistically significative. Right ventricle ejection fraction was significatively lower (59.0 vs 63.2%, p = 0.04). Conclusion Patients admitted during pandemic waves had a larger myocardial scar, bigger left ventricular volume and lower ejection fraction. According to literature, this have mainly been caused by the long presentation time from symptoms to hospital admission3. Considering that the extension of the post-infarct myocardial scar visible on cardiac magnetic resonance imaging strongly correlates with the short- and long-term prognosis4-5, these data suggest that COVID 19 had and will have in the coming years a significant impact on mortality from myocardial infarction.