Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement

Mahesh K. Vidula, Justyna Rajewska-Tabor, J. Jane Cao, Yu Kang, Jason Craft, Winifred Mei, Preethi S. Chandrasekaran, Daniel E. Clark, Ana Maria Poenar, Miroslawa Gorecka, Maan Malahfji, Eilidh Cowan, Jennifer M. Kwan, Samuel W. Reinhardt, Sarah Al-Tabatabaee, Patrick Doeblin, Adriana D.M. Villa, Ilya Karagodin, Nazia Alvi, Panagiota ChristiaNicholas Spetko, Mark Philip Cassar, Christine Park, Lakshmi Nambiar, Alper Turgut, Mahan Roosta Azad, Moritz Lambers, Timothy C. Wong, Michael Salerno, Jiwon Kim, Michael Elliott, Betty Raman, Stefan Neubauer, Connie W. Tsao, Gina LaRocca, Amit R. Patel, Amedeo Chiribiri, Sebastian Kelle, Lauren A. Baldassarre, Dipan J. Shah, Sean G. Hughes, Matthew S. Tong, Malgorzata Pyda, Orlando P. Simonetti, Sven Plein, Yuchi Han*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

Background: Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood. Objectives: The purpose of this study was to characterize myocardial injury in a multicenter cohort of patients with COVID-19 and suspected cardiac involvement referred for cardiac magnetic resonance (CMR). Methods: This retrospective study consisted of 1,047 patients from 18 international sites with polymerase chain reaction–confirmed COVID-19 infection who underwent CMR. Myocardial injury was characterized as acute myocarditis, nonacute/nonischemic, acute ischemic, and nonacute/ischemic patterns on CMR. Results: In this cohort, 20.9% of patients had nonischemic injury patterns (acute myocarditis: 7.9%; nonacute/nonischemic: 13.0%), and 6.7% of patients had ischemic injury patterns (acute ischemic: 1.9%; nonacute/ischemic: 4.8%). In a univariate analysis, variables associated with acute myocarditis patterns included chest discomfort (OR: 2.00; 95% CI: 1.17-3.40, P = 0.01), abnormal electrocardiogram (ECG) (OR: 1.90; 95% CI: 1.12-3.23; P = 0.02), natriuretic peptide elevation (OR: 2.99; 95% CI: 1.60-5.58; P = 0.0006), and troponin elevation (OR: 4.21; 95% CI: 2.41-7.36; P < 0.0001). Variables associated with acute ischemic patterns included chest discomfort (OR: 3.14; 95% CI: 1.04-9.49; P = 0.04), abnormal ECG (OR: 4.06; 95% CI: 1.10-14.92; P = 0.04), known coronary disease (OR: 33.30; 95% CI: 4.04-274.53; P = 0.001), hospitalization (OR: 4.98; 95% CI: 1.55-16.05; P = 0.007), natriuretic peptide elevation (OR: 4.19; 95% CI: 1.30-13.51; P = 0.02), and troponin elevation (OR: 25.27; 95% CI: 5.55-115.03; P < 0.0001). In a multivariate analysis, troponin elevation was strongly associated with acute myocarditis patterns (OR: 4.98; 95% CI: 1.76-14.05; P = 0.003). Conclusions: In this multicenter study of patients with COVID-19 with clinical suspicion for cardiac involvement referred for CMR, nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present.

Original languageEnglish
Pages (from-to)609-624
Number of pages16
JournalJACC: Cardiovascular Imaging
Volume16
Issue number5
Early online date1 May 2023
DOIs
Publication statusPublished - May 2023

Keywords

  • cardiac magnetic resonance (CMR)
  • COVID-2019
  • myocardial injury

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