tetano
Editor, Senior Moderator
JACC Cardiovasc Imaging
. 2022 Dec 2;S1936-878X(22)00659-3.
doi: 10.1016/j.jcmg.2022.10.021. Online ahead of print.
Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement
Mahesh K Vidula[SUP] 1 [/SUP], Justyna Rajewska-Tabor[SUP] 2 [/SUP], J Jane Cao[SUP] 3 [/SUP], Yu Kang[SUP] 1 [/SUP], Jason Craft[SUP] 3 [/SUP], Winifred Mei[SUP] 3 [/SUP], Preethi S Chandrasekaran[SUP] 4 [/SUP], Daniel E Clark[SUP] 5 [/SUP], Ana-Maria Poenar[SUP] 6 [/SUP], Miroslawa Gorecka[SUP] 6 [/SUP], Maan Malahfji[SUP] 7 [/SUP], Eilidh Cowan[SUP] 7 [/SUP], Jennifer M Kwan[SUP] 8 [/SUP], Samuel W Reinhardt[SUP] 8 [/SUP], Sarah Al-Tabatabaee[SUP] 9 [/SUP], Patrick Doeblin[SUP] 9 [/SUP], Adriana D M Villa[SUP] 10 [/SUP], Ilya Karagodin[SUP] 11 [/SUP], Nazia Alvi[SUP] 11 [/SUP], Panagiota Christia[SUP] 12 [/SUP], Nicholas Spetko[SUP] 13 [/SUP], Mark Philip Cassar[SUP] 14 [/SUP], Christine Park[SUP] 15 [/SUP], Lakshmi Nambiar[SUP] 15 [/SUP], Alper Turgut[SUP] 16 [/SUP], Mahan Roosta Azad[SUP] 17 [/SUP], Moritz Lambers[SUP] 17 [/SUP], Timothy C Wong[SUP] 18 [/SUP], Michael Salerno[SUP] 16 [/SUP], Jiwon Kim[SUP] 15 [/SUP], Michael Elliott[SUP] 19 [/SUP], Betty Raman[SUP] 14 [/SUP], Stefan Neubauer[SUP] 14 [/SUP], Connie W Tsao[SUP] 13 [/SUP], Gina LaRocca[SUP] 12 [/SUP], Amit R Patel[SUP] 11 [/SUP], Amedeo Chiribiri[SUP] 10 [/SUP], Sebastian Kelle[SUP] 9 [/SUP], Lauren A Baldassarre[SUP] 8 [/SUP], Dipan J Shah[SUP] 7 [/SUP], Sean G Hughes[SUP] 5 [/SUP], Matthew S Tong[SUP] 4 [/SUP], Malgorzata Pyda[SUP] 2 [/SUP], Orlando P Simonetti[SUP] 4 [/SUP], Sven Plein[SUP] 6 [/SUP], Yuchi Han[SUP] 20 [/SUP]
Affiliations
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.
Keywords: cardiovascular magnetic resonance; coronavirus disease-2019; myocardial injury.
. 2022 Dec 2;S1936-878X(22)00659-3.
doi: 10.1016/j.jcmg.2022.10.021. Online ahead of print.
Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement
Mahesh K Vidula[SUP] 1 [/SUP], Justyna Rajewska-Tabor[SUP] 2 [/SUP], J Jane Cao[SUP] 3 [/SUP], Yu Kang[SUP] 1 [/SUP], Jason Craft[SUP] 3 [/SUP], Winifred Mei[SUP] 3 [/SUP], Preethi S Chandrasekaran[SUP] 4 [/SUP], Daniel E Clark[SUP] 5 [/SUP], Ana-Maria Poenar[SUP] 6 [/SUP], Miroslawa Gorecka[SUP] 6 [/SUP], Maan Malahfji[SUP] 7 [/SUP], Eilidh Cowan[SUP] 7 [/SUP], Jennifer M Kwan[SUP] 8 [/SUP], Samuel W Reinhardt[SUP] 8 [/SUP], Sarah Al-Tabatabaee[SUP] 9 [/SUP], Patrick Doeblin[SUP] 9 [/SUP], Adriana D M Villa[SUP] 10 [/SUP], Ilya Karagodin[SUP] 11 [/SUP], Nazia Alvi[SUP] 11 [/SUP], Panagiota Christia[SUP] 12 [/SUP], Nicholas Spetko[SUP] 13 [/SUP], Mark Philip Cassar[SUP] 14 [/SUP], Christine Park[SUP] 15 [/SUP], Lakshmi Nambiar[SUP] 15 [/SUP], Alper Turgut[SUP] 16 [/SUP], Mahan Roosta Azad[SUP] 17 [/SUP], Moritz Lambers[SUP] 17 [/SUP], Timothy C Wong[SUP] 18 [/SUP], Michael Salerno[SUP] 16 [/SUP], Jiwon Kim[SUP] 15 [/SUP], Michael Elliott[SUP] 19 [/SUP], Betty Raman[SUP] 14 [/SUP], Stefan Neubauer[SUP] 14 [/SUP], Connie W Tsao[SUP] 13 [/SUP], Gina LaRocca[SUP] 12 [/SUP], Amit R Patel[SUP] 11 [/SUP], Amedeo Chiribiri[SUP] 10 [/SUP], Sebastian Kelle[SUP] 9 [/SUP], Lauren A Baldassarre[SUP] 8 [/SUP], Dipan J Shah[SUP] 7 [/SUP], Sean G Hughes[SUP] 5 [/SUP], Matthew S Tong[SUP] 4 [/SUP], Malgorzata Pyda[SUP] 2 [/SUP], Orlando P Simonetti[SUP] 4 [/SUP], Sven Plein[SUP] 6 [/SUP], Yuchi Han[SUP] 20 [/SUP]
Affiliations
- PMID: 36752429
- DOI: 10.1016/j.jcmg.2022.10.021
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.
Keywords: cardiovascular magnetic resonance; coronavirus disease-2019; myocardial injury.