Abstract
IntroductionThis observational CMR study aims to characterize left-ventricular (LV) damage, which may be specifically attributed to COVID-19 and is distant in time from the acute phase, through serial CMR performed during the first year in patients with no prior cardiac disease.MethodsThis study included consecutive patients without any prior history of cardiac disease but with a peak troponin-Ic > 50 ng/ml at the time of the first COVID-wave. All had a CMR in the first months after the acute phase, and some had an additional CMR at the end of the first year to monitor LV function, remodeling, and abnormalities evocative of myositis and myocarditis - i.e., increased T1/T2 relaxation times, increased extracellular volume (ECV), and delayed contrast enhancement.ResultsNineteen consecutively admitted COVID-19 patients (17 men, median age 66 [57–71] years) were included. Eight (42%) had hypertension, six (32%) were obese, and 16 (84%) had suffered an acute respiratory distress syndrome. The 1st CMR, recorded at a median 3.2 [interquartile range: 2.6–3.9] months from the troponin peak, showed (1) LV concentric remodeling in 12 patients (63%), (2) myocardial tissue abnormalities in 11 (58%), including 9 increased myocardial ECVs, and (3) 14 (74%) increased ECVs from shoulder skeletal muscles. The 2nd CMR, obtained at 11.1 [11.0–11.7] months from the troponin peak in 13 patients, showed unchanged LV function and remodeling but a return to normal or below the normal range for all ECVs of the myocardium and skeletal muscles.ConclusionMany patients with no history of cardiac disease but for whom an increase in blood troponin-Ic ascertained COVID-19 induced myocardial damage exhibited signs of persistent extracellular edema at a median 3-months from the troponin peak, affecting the myocardium and skeletal muscles, which resolved within a one-year time frame. Associations with long-COVID symptoms need to be investigated on a larger scale now.Clinical Trial RegistrationNCT04753762 on the ClinicalTrials.gov site.
Highlights
This observational Cardiac Magnetic Resonance (CMR) study aims to characterize the leftventricular (LV) damage which may be attributed to COVID-19 and distant in time from the acute phase, through serial CMR planned during the first year in patients with no previous history of cardiac disease but with significant increases in blood troponin-Ic during the initial COVID19 hospitalization
Additional inclusion criteria were: (i) a peak troponin Ic > 50 ng/ml measured during hospitalization, (ii) the absence of any prior cardiac disease history, and (iii) health conditions required to endure the CMR-based monitoring which is currently prescribed for myocarditis patients in our center
Seventeen patients (89%) were male, 11 (58%) had previously been identified with hypertension or obesity (6 with obesity and 8 with hypertension), and as many as 16 (84%) had been affected by an acute respiratory distress syndrome (ARDS) requiring mechanical ventilation at the acute phase
Summary
This observational CMR study aims to characterize left-ventricular (LV) damage, which may be attributed to COVID-19 and is distant in time from the acute phase, through serial CMR performed during the first year in patients with no prior cardiac disease. There is, an urgent need to specify the nature of COVID-19 induced myocardial damage and investigate its impact over time. Cardiac Magnetic Resonance (CMR) already documented myocardial tissue abnormalities at the acute or sub-acute phase of COVID-19 and, increases in myocardial T1 and T2 relaxation times and an increased extracellular volume (ECV) [5, 6]. This observation was at the time attributed to inflammatory edema. Myositis with skeletal muscle edema is frequently observed during COVID-19 [8]
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