Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)

• Published in: JAMA cardiology Vol. 5; no. 11; p. 1265
• Main Authors: Puntmann, Valentina O, Carerj, M Ludovica, Wieters, Imke, Fahim, Masia, Arendt, Christophe, Hoffmann, Jedrzej, Shchendrygina, Anastasia, Escher, Felicitas, Vasa-Nicotera, Mariuca, Zeiher, Andreas M, Vehreschild, Maria, Nagel, Eike
• Format: Journal Article
• Language: English
• Published: United States 01-11-2020
• Subjects: Adult; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - virology; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - metabolism; Cardiovascular Diseases - virology; Case-Control Studies; Cohort Studies; Contrast Media - administration & dosage; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - mortality; COVID-19 - virology; Female; Gadolinium; Germany - epidemiology; Humans; Magnetic Resonance Imaging - methods; Male; Middle Aged; Myocarditis - etiology; Myocarditis - virology; Myocardium - pathology; Prospective Studies; Recovery of Function; SARS-CoV-2 - genetics; Stroke Volume; Troponin T - blood; Ventricular Function, Left - physiology; Germany
• ISSN: 2380-6591
• DOI: 10.1001/jamacardio.2020.3557

Coronavirus disease 2019 (COVID-19) continues to cause considerable morbidity and mortality worldwide. Case reports of hospitalized patients suggest that COVID-19 prominently affects the cardiovascular system, but the overall impact remains unknown.
To evaluate the presence of myocardial injury in unselected patients recently recovered from COVID-19 illness.
In this prospective observational cohort study, 100 patients recently recovered from COVID-19 illness were identified from the University Hospital Frankfurt COVID-19 Registry between April and June 2020.
Recent recovery from severe acute respiratory syndrome coronavirus 2 infection, as determined by reverse transcription-polymerase chain reaction on swab test of the upper respiratory tract.
Demographic characteristics, cardiac blood markers, and cardiovascular magnetic resonance (CMR) imaging were obtained. Comparisons were made with age-matched and sex-matched control groups of healthy volunteers (n = 50) and risk factor-matched patients (n = 57).
Of the 100 included patients, 53 (53%) were male, and the mean (SD) age was 49 (14) years. The median (IQR) time interval between COVID-19 diagnosis and CMR was 71 (64-92) days. Of the 100 patients recently recovered from COVID-19, 67 (67%) recovered at home, while 33 (33%) required hospitalization. At the time of CMR, high-sensitivity troponin T (hsTnT) was detectable (greater than 3 pg/mL) in 71 patients recently recovered from COVID-19 (71%) and significantly elevated (greater than 13.9 pg/mL) in 5 patients (5%). Compared with healthy controls and risk factor-matched controls, patients recently recovered from COVID-19 had lower left ventricular ejection fraction, higher left ventricle volumes, and raised native T1 and T2. A total of 78 patients recently recovered from COVID-19 (78%) had abnormal CMR findings, including raised myocardial native T1 (n = 73), raised myocardial native T2 (n = 60), myocardial late gadolinium enhancement (n = 32), or pericardial enhancement (n = 22). There was a small but significant difference between patients who recovered at home vs in the hospital for native T1 mapping (median [IQR], 1119 [1092-1150] ms vs 1141 [1121-1175] ms; P = .008) and hsTnT (4.2 [3.0-5.9] pg/dL vs 6.3 [3.4-7.9] pg/dL; P = .002) but not for native T2 mapping. None of these measures were correlated with time from COVID-19 diagnosis (native T1: r = 0.07; P = .47; native T2: r = 0.14; P = .15; hsTnT: r = -0.07; P = .50). High-sensitivity troponin T was significantly correlated with native T1 mapping (r = 0.33; P < .001) and native T2 mapping (r = 0.18; P = .01). Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation. Native T1 and T2 were the measures with the best discriminatory ability to detect COVID-19-related myocardial pathology.
In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.