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Myocardial Injury on CMR in Patients With COVID-19
Quick Takes
- Nonischemic and ischemic injury patterns are frequent in patients with COVID-19 across various patient subgroups.
- Specifically, patients with COVID-19 with clinical findings including cardiac symptoms, ECG abnormalities, and biomarker elevations are at higher risk of having CMR findings consistent with acute myocarditis or acute infarction.
- Additional studies are indicated to better understand the prognostic significance of the CMR findings.
Study Questions:
What are the cardiac magnetic resonance (CMR) characteristics of myocardial injury in patients with coronavirus disease 2019 (COVID-19), and factors associated with acute myocarditis and acute ischemic patterns?
Methods:
The investigators conducted a multicenter retrospective study 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. Logistic regression was performed to assess the relationship between various parameters and acute myocarditis/acute ischemic patterns.
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 (odds ratio [OR], 2.00; 95% confidence interval [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:
The authors report that nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present in patients with COVID-19.
Perspective:
This multicenter study reports that nonischemic and ischemic injury patterns are frequent in patients with COVID-19 across various patient subgroups, and identified clinical variables associated with acute myocarditis and acute ischemic patterns. Specifically, patients with COVID-19 with clinical findings including cardiac symptoms, ECG abnormalities, and biomarker elevations are at higher risk of having CMR findings consistent with acute myocarditis or acute infarction. While these findings further our understanding of the characteristics and patterns of myocardial injury in patients with COVID-19, additional studies are indicated to better understand the prognostic significance of these findings.
Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Magnetic Resonance Imaging
Keywords: Biomarkers, Chest Pain, Coronary Artery Disease, Critical Care, COVID-19, Diagnostic Imaging, Electrocardiography, Heart Failure, Heart Injuries, Infarction, Magnetic Resonance Imaging, Myocardial Infarction, Myocardial Ischemia, Myocarditis, Primary Prevention, Troponin
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