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Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance

2021; Oxford University Press; Volume: 42; Issue: 19 Linguagem: Inglês

10.1093/eurheartj/ehab075

1522-9645

Tushar Kotecha, Daniel Knight, Yousuf Razvi, Kartik Kumar, Kavitha Vimalesvaran, George Thornton, Rishi Patel, Liza Chacko, James Brown, Clare Coyle, Donald Leith, Abhishek Shetye, Ben Ariff, Robert M. Bell, Gabriella Captur, Meg Coleman, James Goldring, Deepa Gopalan, Melissa Heightman, Toby Hillman, Luke Howard, Michael Jacobs, Paramjit Jeetley, Prapa Kanagaratnam, Onn Min Kon, Lucy Lamb, Charlotte Manisty, Palmira Mathurdas, Jamil Mayet, Rupert Negus, Niket Patel, Iain Pierce, Georgina Russell, Anthony Wolff, Hui Xue, Peter Kellman, James Moon, Thomas A. Treibel, Graham Cole, Marianna Fontana,

COVID-19 Clinical Research Studies

Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients.One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction; of these, 30% had active myocarditis. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms).During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.