Patterns of myocardial injury in patients recovered from COVID-19: findings on cardiac magnetic resonance imaging studies and their prognosis

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Abstract

Background: COVID-19 continues to cause significant mortality and morbidity worldwide. Cardiac involvement is associated
with long-term and medium-term negative clinical outcomes. Cardiac magnetic resonance imaging (CMRI) is a useful technique
to detect and characterize myocardial disorders, so it has been used to identify different post-COVID-19 complications.
Objective: This study was aimed to evaluate the presence, the type, and the 6-month prognosis of the CMRI findings in an
unselected cohort of patients referred to our site.
Methods: MSingle-center, prospective, observational cohort study. We included consecutive patients referred to our site for a
CMRI. They were classified into five groups: normal CMRI (Group A), nonspecific myocardial fibrosis (Group B), isolated
myocardial inflammation (Group C), myocarditis (Group D) and ischemic myocardial fibrosis (Group E). A 6-month followup
was performed.
Results: We enrolled 298 patients, 51% women. CMRI was performed at a median of 68 days following epidemiological discharge.
Patients were assigned to the groups as follows: 64.5% to Group A, 21.8% to Group B, and 10.4% to Group C. CMRI
was repeated in six patients, and it showed that altered basal levels returned to normal. Six patients in Group D (2%) were
diagnosed with myocarditis, and four in Group E (1.3%) suffered from myocardial infarction. Two patients in Group E underwent
a revascularization procedure during their follow-up. The remaining cohort did not suffer from any event.
Conclusion: No pathological findings were found on most patients’ CMRI (86%). Given the scale of the pandemic, we do not
consider advisable to assess post-COVID-19 cardiac complications in general population by means of CMRI. In contrast, CMRI
should be performed on those patients suspected of myocardial injury.