Multimodality Cardiac Imaging, Cardiac Symptoms, and Clinical Outcomes in Patients Who Recovered from Mild COVID-19.

Background Many patients have persistent cardiac symptoms after mild COVID-19. However, studies assessing the relationship between symptoms and cardiac imaging are limited. Purpose To assess the relationship between multi-modality cardiac imaging parameters, symptoms, and clinical outcomes in patients recovered from mild COVID-19 compared to COVID-19 negative controls. Materials and Methods Patients who underwent PCR testing for SARS-CoV-2 between August 2020 and January 2022 were invited to participate in this prospective, single-center study. Participants underwent cardiac MRI, echocardiography, and assessment of cardiac symptoms at 3-6 months after SARS-CoV-2 testing. Cardiac symptoms and outcomes were also evaluated at 12-18 months. Statistical analysis included Fisher's exact test and logistic regression. Results This study included 122 participants who recovered from COVID-19 ([COVID+] mean age, 42 years ± 13 [SD]; 73 females) and 22 COVID-19 negative controls (mean age, 46 years ± 16 [SD]; 13 females). At 3-6 months, 20% (24/122) and 44% (54/122) of COVID+ participants had at least one abnormality on echocardiography and cardiac MRI, respectively, which did not differ compared to controls (23% [5/22]; P = .77 and 41% [9/22]; P = .82, respectively). However, COVID+ participants more frequently reported cardiac symptoms at 3-6 months compared to controls (48% [58/122] vs. 23% [4/22]; P = .04). An increase in native T1 (10 ms) was associated with increased odds of cardiac symptoms at 3-6 months (OR, 1.09 [95% CI: 1.00, 1.19]; P = .046) and 12-18 months (OR, 1.14 [95% CI: 1.01, 1.28]; P = .028). No major adverse cardiac events occurred during follow-up. Conclusion Patients recovered from mild COVID-19 reported increased cardiac symptoms 3-6 months after diagnosis compared to controls, but the prevalence of abnormalities on echocardiography and cardiac MRI did not differ between groups. Elevated native T1 was associated with cardiac symptoms 3-6 months and 12-18 months after mild COVID-19.

[1]  Jiwon Kim,et al.  Cardiovascular magnetic resonance for evaluation of cardiac involvement in COVID-19: recommendations by the Society for Cardiovascular Magnetic Resonance , 2023, Journal of Cardiovascular Magnetic Resonance.

[2]  P. Thavendiranathan,et al.  Magnetic Resonance Imaging of Cardiovascular Manifestations Following COVID‐19 , 2023, Journal of magnetic resonance imaging : JMRI.

[3]  J. Fish,et al.  Myocardial Inflammation at FDG PET/MRI and Clinical Outcomes in Symptomatic and Asymptomatic Participants after COVID-19 Vaccination , 2023, Radiology. Cardiothoracic imaging.

[4]  Steffen E. Petersen,et al.  Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank , 2022, Heart.

[5]  Simon S. Martin,et al.  Long-term cardiac pathology in individuals with mild initial COVID-19 illness , 2022, Nature Medicine.

[6]  B. Wintersperger,et al.  Clinical Impact of Cardiac MRI T1 and T2 Parametric Mapping in Patients with Suspected Cardiomyopathy. , 2022, Radiology.

[7]  Matthew W. Martinez,et al.  2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play , 2022, Journal of the American College of Cardiology.

[8]  R. Wald,et al.  Myocardial Injury Pattern at MRI in COVID-19 Vaccine–Associated Myocarditis , 2022, Radiology.

[9]  M. Radisic,et al.  Cardiovascular signatures of COVID-19 predict mortality and identify barrier stabilizing therapies , 2022, eBioMedicine.

[10]  Benjamin Bowe,et al.  Long-term cardiovascular outcomes of COVID-19 , 2022, Nature Medicine.

[11]  J. Fish,et al.  Combined Cardiac Fluorodeoxyglucose-Positron Emission Tomography/Magnetic Resonance Imaging Assessment of Myocardial Injury in Patients Who Recently Recovered From COVID-19. , 2022, JAMA cardiology.

[12]  P. Kellman,et al.  Prospective Case-Control Study of Cardiovascular Abnormalities 6 Months Following Mild COVID-19 in Healthcare Workers , 2021, JACC: Cardiovascular Imaging.

[13]  P. Kellman,et al.  Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance , 2021, European heart journal.

[14]  W. Gong,et al.  Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. , 2020, JAMA cardiology.

[15]  E. Nagel,et al.  Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update , 2020, Journal of Cardiovascular Magnetic Resonance.

[16]  B. Wintersperger,et al.  Loss of base-to-apex circumferential strain gradient assessed by cardiovascular magnetic resonance in Fabry disease: relationship to T1 mapping, late gadolinium enhancement and hypertrophy , 2019, Journal of Cardiovascular Magnetic Resonance.

[17]  R. Wald,et al.  Noninvasive hematocrit assessment for cardiovascular magnetic resonance extracellular volume quantification using a point-of-care device and synthetic derivation , 2018, Journal of Cardiovascular Magnetic Resonance.

[18]  Patrizio Lancellotti,et al.  Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2016, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[19]  Victor Mor-Avi,et al.  Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2015, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.