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Open accessJournal ArticleDOI: 10.1148/RYCT.2021200628

Cardiac MRI in Suspected Acute COVID-19 Myocarditis

04 Mar 2021-Radiology: Cardiothoracic Imaging (Radiological Society of North America)-Vol. 3, Iss: 2
Abstract: Participants with active and symptomatic COVID-19 infection and suspected acute myocarditis had distinct pathologic findings at cardiac MRI with diffuse myocardial edema, which could be best depict...

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Topics: Myocarditis (58%), Coronavirus (53%)
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6 results found


Open accessJournal ArticleDOI: 10.2147/IJGM.S321156
Abstract: Background: In the post-acute COVID-19 syndrome, many patients suffer from palpitations, effort-associated fatigue, and even sudden death. The mechanism of heart involvement in this syndrome is uncertain. The main purpose of the study was to identify possible cardiac involvement causes in patients with post-acute COVID-19 by using biomarkers such as NT-proBNP and nitric oxide (NO) and cardiac imaging modalities. Methods: In this cross-sectional study, a total of 105 participants were included according to the existence of symptoms, and 40 of these participants were asymptomatic patients. The ages of the participants ranged from 20 to 50 years. All patients were healthy before COVID-19. The symptoms were defined as palpitations and/or fatigue association with exercise in post-acute COVID-19 term. The comparison of the two groups was made by using biochemical parameters (NT-proBNP, Troponin I, NO) and imaging techniques (echocardiography, cardiovascular magnetic resonance (CMR) and cardiac positron emission tomography (PET)). Results: The symptomatic patients had higher NT-proBNP levels compared with asymptomatic patients (132.30 +/- 35.15;76.86 +/- 16.79, respectively;p < 0.001). Interestingly, the symptomatic patients had lower NO levels than asymptomatic patients (9.20 +/- 3.08;16.15 +/- 6.02, respectively;p < 0.001). Echocardiography and CMR were normal. However, we found regional increased 18F-FDG uptake on cardiac PET to be compatible with myocardial fatigue. Conclusion: We found elevated NT-proNBP levels, low serum NO levels, and increased 18F-FDG uptake on cardiac PET in post-acute COVID syndrome. Cardiac PET could replace or be added to CMR for detecting subtle subacute/chronic myocarditis. The follow-up of patients with post-acute COVID-19 could target the possibility of risk of heart failure.

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Topics: Cardiac PET (60%), Sudden death (57%), Asymptomatic (56%) ... show more

Open accessJournal ArticleDOI: 10.4329/WJR.V13.I9.283
Lavannya Atri1, Michael C Morgan1, Sean Harrell1, Wael AlJaroudi1  +1 moreInstitutions (1)
Abstract: There is a growing evidence of cardiovascular complications in coronavirus disease 2019 (COVID-19) patients. As evidence accumulated of COVID-19 mediated inflammatory effects on the myocardium, substantial attention has been directed towards cardiovascular imaging modalities that facilitate this diagnosis. Cardiac magnetic resonance imaging (CMRI) is the gold standard for the detection of structural and functional myocardial alterations and its role in identifying patients with COVID-19 mediated cardiac injury is growing. Despite its utility in the diagnosis of myocardial injury in this population, CMRI's impact on patient management is still evolving. This review provides a framework for the use of CMRI in diagnosis and management of COVID-19 patients from the perspective of a cardiologist. We review the role of CMRI in the management of both the acutely and remotely COVID-19 infected patient. We discuss patient selection for this imaging modality; T1, T2, and late gadolinium enhancement imaging techniques; and previously described CMRI findings in other cardiomyopathies with potential implications in COVID-19 recovered patients.

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Open accessJournal ArticleDOI: 10.1136/HEARTJNL-2021-320246
16 Oct 2021-Heart
Abstract: Since the inception of the COVID-19 pandemic, the identification of factors associated with unfavourable outcomes has been a topic of intense investigation. With limited disease-specific therapies, early stratification of those at highest risk of complications can guide who needs intensive clinical monitoring and supportive management. The large body of evidence in the early phases of the pandemic strongly suggested that cardiac involvement could potentially be one of these prognostic factors, and several hypotheses have been raised for the cardiovascular abnormalities observed, especially in severely ill patients. Markers of acute myocardial injury have been reported in up to one-fifth of patients with COVID-19,1 and several mechanisms have been implicated: (a) direct myocardial injury due to viral invasion of cardiomyocytes; (b) systemic inflammatory response and cytokine storm; (c) increased cardiometabolic demand associated with acute hypoxic respiratory failure; (d) increased vascular shear stress precipitating plaque rupture in the setting of a prothrombotic state; (e) deleterious cardiovascular effects of empirical drug regimens; (f) critical electrolyte disturbances. These disease-related mechanisms may be exacerbated by underlying cardiac disease and increase risk of adverse outcomes.1 The present study by Singh et al 2 brings a significant contribution to this growing body of evidence. Fifty-two patients recovered from COVID-19 (one-third with intensive care admission and one-fifth requiring mechanical ventilation) underwent a comprehensive imaging protocol with gadolinium and manganese-enhanced MRI, with 23 additionally undergoing CT coronary angiography for evaluation of underlying coronary artery disease. They were compared with 10 healthy controls and 26 volunteers propensity matched for cardiovascular morbidity. COVID-19-recovered patients demonstrated impaired left (LV) and right (RV) ventricular systolic function, elevated myocardial T1 values and extracellular volume fraction, and reduced myocardial manganese uptake compared with healthy controls. In contrast, when comparing with comorbidity-matched volunteers, patients with COVID-19 had preserved LV function but reduced RV systolic function …

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Topics: Coronary artery disease (57%)


Open accessJournal ArticleDOI: 10.1148/RADIOL.2021211162
10 Aug 2021-Radiology
Abstract: Background Myocardial injury and inflammation at cardiac MRI in patients with COVID-19 have been described in recent publications. Concurrently, a chronic COVID-19 syndrome (CCS) after SARS-CoV-2 infection has been observed and manifests with symptoms such as fatigue and exertional dyspnea. Purpose To explore the relationship between CCS and myocardial injury and inflammation as an underlying cause of the persistent complaints in previously healthy individuals. Materials and Methods In this prospective study from January 2021 to April 2021, study participants without known cardiac or pulmonary diseases prior to SARS-CoV-2 infection who had persistent CCS symptoms such as fatigue or exertional dyspnea after convalescence and healthy control participants underwent cardiac MRI. The cardiac MRI protocol included evaluating the T1 and T2 relaxation times, extracellular volume, T2 signal intensity ratio, and late gadolinium enhancement (LGE). Student t tests, Mann-Whitney U tests, and χ2 tests were used for statistical analysis. Results Forty-one participants with CCS (mean age, 39 years ± 13 [standard deviation]; 18 men) and 42 control participants (mean age, 39 years ± 16; 26 men) were evaluated. The median time between the initial incidence of mild to moderate COVID-19 not requiring hospitalization and undergoing cardiac MRI was 103 days (interquartile range, 88-158 days). Troponin T levels were normal. Parameters indicating myocardial inflammation and edema were comparable between participants with CCS and control participants (T1 relaxation times: 978 msec ± 23 vs 971 msec ± 25 [P = .17]; T2 relaxation times: 53 msec ± 2 vs 52 msec ± 2 [P = .47]; T2 signal intensity ratios: 1.6 ± 0.2 vs 1.6 ± 0.3 [P = .10]). Visible myocardial edema was present in none of the participants. Three of 41 (7%) participants with CCS demonstrated nonischemic LGE, whereas no participants in the control group demonstrated nonischemic LGE (0 of 42 [0%]; P = .07). None of the participants fulfilled the 2018 Lake Louise criteria for the diagnosis of myocarditis. Conclusion Individuals with chronic COVID-19 syndrome who did not undergo hospitalization for COVID-19 did not demonstrate signs of active myocardial injury or inflammation at cardiac MRI. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lima and Bluemke in this issue.

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Open accessJournal ArticleDOI: 10.1001/JAMACARDIO.2020.0950
Shaobo Shi1, Mu Qin2, Bo Shen1, Yuli Cai1  +9 moreInstitutions (2)
25 Mar 2020-JAMA Cardiology
Abstract: Importance Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. However, information on cardiac injury in patients affected by COVID-19 is limited. Objective To explore the association between cardiac injury and mortality in patients with COVID-19. Design, Setting, and Participants This cohort study was conducted from January 20, 2020, to February 10, 2020, in a single center at Renmin Hospital of Wuhan University, Wuhan, China; the final date of follow-up was February 15, 2020. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study. Main Outcomes and Measures Clinical laboratory, radiological, and treatment data were collected and analyzed. Outcomes of patients with and without cardiac injury were compared. The association between cardiac injury and mortality was analyzed. Results A total of 416 hospitalized patients with COVID-19 were included in the final analysis; the median age was 64 years (range, 21-95 years), and 211 (50.7%) were female. Common symptoms included fever (334 patients [80.3%]), cough (144 [34.6%]), and shortness of breath (117 [28.1%]). A total of 82 patients (19.7%) had cardiac injury, and compared with patients without cardiac injury, these patients were older (median [range] age, 74 [34-95] vs 60 [21-90] years;P Conclusions and Relevance Cardiac injury is a common condition among hospitalized patients with COVID-19 in Wuhan, China, and it is associated with higher risk of in-hospital mortality.

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Topics: Heart Injury (51%), Cohort study (50%)

2,412 Citations


Open accessJournal ArticleDOI: 10.1016/J.JACC.2020.08.059
Gennaro Giustino1, Sean Pinney1, Anuradha Lala1, Vivek Y. Reddy1  +4 moreInstitutions (1)
Abstract: The cardiovascular system is affected broadly by severe acute respiratory syndrome coronavirus 2 infection. Both direct viral infection and indirect injury resulting from inflammation, endothelial activation, and microvascular thrombosis occur in the context of coronavirus disease 2019. What determines the extent of cardiovascular injury is the amount of viral inoculum, the magnitude of the host immune response, and the presence of co-morbidities. Myocardial injury occurs in approximately one-quarter of hospitalized patients and is associated with a greater need for mechanical ventilator support and higher hospital mortality. The central pathophysiology underlying cardiovascular injury is the interplay between virus binding to the angiotensin-converting enzyme 2 receptor and the impact this action has on the renin-angiotensin system, the body's innate immune response, and the vascular response to cytokine production. The purpose of this review was to describe the mechanisms underlying cardiovascular injury, including that of thromboembolic disease and arrhythmia, and to discuss their clinical sequelae.

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Topics: Cardiovascular Injury (67%), Coronavirus (54%)

54 Citations


Open accessJournal ArticleDOI: 10.1016/J.JCMG.2020.06.003
Abstract: Novel coronavirus infection causes a systemic disease (coronavirus disease-2019 [COVID-19]) with, most frequently, respiratory involvement. In addition to systemic and respiratory complications, COVID-19 can reveal itself as a myocarditis-like syndrome (AMCovS), whose underlying mechanism is largely

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Topics: Coronavirus (60%), Myocarditis (53%)

31 Citations


Open accessJournal ArticleDOI: 10.1148/RYCT.2019190010
Julian A. Luetkens1, Anton Faron1, Alexander Isaak1, Darius Dabir1  +5 moreInstitutions (1)
Abstract: The 2018 Lake Louise criteria provide a high diagnostic accuracy for the diagnosis of acute myocarditis and significantly increase the sensitivity compared with the original score.

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31 Citations


Journal ArticleDOI: 10.1148/RADIOL.2020201057
18 Aug 2020-Radiology
Abstract: Background Cardiac involvement in liver cirrhosis in the absence of underlying cardiac disease is termed cirrhotic cardiomyopathy. The pathophysiology of this condition is still poorly understood. Purpose To investigate the extent of subclinical imaging changes in terms of fibrosis and inflammation and to explore the relationship between the severity of liver disease and the degree of myocardial involvement. Materials and Methods In this prospective study from November 2018 to December 2019, participants with liver cirrhosis and healthy control participants underwent hepatic and cardiac MRI. The multiparametric scan protocol assessed hepatic (T1 and T2 relaxation times, extracellular volume [ECV], and MR elastography-based liver stiffness) and cardiac (T1 and T2 relaxation times, ECV, myocardial edema, late gadolinium enhancement [LGE], and myocardial strain) parameters. Student t tests, one-way analysis of variance, Pearson correlation, and multivariable binary regression analysis were used for statistical analyses. Results A total of 42 participants with liver cirrhosis (mean age ± standard deviation, 57 years ± 11; 23 men) and 18 control participants (mean age, 54 years ± 19; 11 men) were evaluated. Compared with control participants, the participants with liver cirrhosis displayed reduced longitudinal strain and elevated markers of myocardial disease (T1 and T2 relaxation times, ECV, and qualitative and quantitative LGE). Myocardial T1 (978 msec ± 23 vs 1006 msec ± 29 vs 1044 msec ± 14; P < .001) and T2 relaxation times (56 msec ± 4 vs 59 msec ± 3 vs 62 msec ± 8; P = .04) and ECV (30% ± 5 vs 33% ± 5 vs 38% ± 7; P = .009) were higher depending on Child-Pugh class (A vs B vs C). Positive LGE lesions (three of 11 [27%] vs 10 of 19 [53%] vs nine of 11 [82%]; P = .04) were more prevalent in advanced Child-Pugh classes. MR elastography-based liver stiffness was an independent predictor for LGE (odds ratio, 1.6; 95% confidence interval: 1.2%, 2.1%; P = .004) and correlated with quantitative LGE (r = 0.67; P < .001), myocardial T1 relaxation times (r = 0.55; P < .001), and ECV (r = 0.39; P = .01). Conclusion In participants with liver cirrhosis, systolic dysfunction and elevated parameters of myocardial edema and fibrosis were observed at MRI, which were more abnormal with greater severity of liver disease. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by de Roos and Lamb in this issue.

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Topics: Liver disease (54%), Cirrhosis (53%)

11 Citations


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