CARDIOVASCULAR RADIOLOGY / ORIGINAL PAPER
Comparing myocardial injury patterns and outcomes in cardiac magnetic resonance imaging between COVID-19- and non-COVID-19-related myocarditis
1
Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
2
Department of Imaging, Shiraz University of Medical Sciences, Shiraz, Iran
3
Department of Radiology, Rajaie Cardiovascular and Medical Research Center, Iran University of Medical Sciences, Tehran, Iran
4
Department of Cardiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
5
Department of Cardiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Submission date: 2024-10-01
Final revision date: 2024-12-03
Acceptance date: 2024-12-21
Publication date: 2025-01-22
Corresponding author
Shayan Mirshafiee
Department of Cardiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Department of Cardiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Pol J Radiol, 2025; 90: 36-45
KEYWORDS
TOPICS
ABSTRACT
Purpose:
Despite the low incidence of COVID myocarditis, its influence on outcomes is substantial. The pivotal role of cardiac magnetic resonance (CMR) in diagnosing myocarditis is considered to be associated with disease prognosis. The primary objective of this study was to conduct a comparative analysis of myocardial injury patterns, CMR pathologic features, outcomes, and their correlation with CMR findings in COVID- and non-COVID-related myocarditis.
Material and methods:
This historical cohort study involved 124 patients diagnosed with myocarditis (COVID-19 or non-COVID-19), who underwent CMR between 2018 and 2021. The COVID group consisted of 70 individuals with a definite history of COVID-19 infection within 4 weeks, and the non-COVID group comprised 54 individuals who had no prior exposure to the SARS-CoV-2 virus. All patients were monitored for one year to assess the incidence of major adverse cardiovascular events (MACE). Additionally, baseline and follow-up echocardiography data were obtained with a minimum 3-month interval.
Results:
In comparison between two groups regarding to indices of CMR, left ventricular (LV) ejection fraction (p < 0.001), right ventricular (RV) ejection fraction (p < 0.001) were significantly lower in non-COVID group, and significant LV and RV systolic dysfunction were meaningfully lower in the COVID group. Extension of late gadolinium enhancement (LGE) was significantly greater in COVID group. Finally, the incidence of MACE and mean event-free survival did not have significant difference between two groups.
Conclusions:
Although CMR findings differed between the 2 groups, there was no significant difference in the risk of MACE or survival during one-year follow-up. Notably, LV and RV dysfunction were more prevalent in the non-COVID group, while extension of LGE was greater in the COVID group.
Despite the low incidence of COVID myocarditis, its influence on outcomes is substantial. The pivotal role of cardiac magnetic resonance (CMR) in diagnosing myocarditis is considered to be associated with disease prognosis. The primary objective of this study was to conduct a comparative analysis of myocardial injury patterns, CMR pathologic features, outcomes, and their correlation with CMR findings in COVID- and non-COVID-related myocarditis.
Material and methods:
This historical cohort study involved 124 patients diagnosed with myocarditis (COVID-19 or non-COVID-19), who underwent CMR between 2018 and 2021. The COVID group consisted of 70 individuals with a definite history of COVID-19 infection within 4 weeks, and the non-COVID group comprised 54 individuals who had no prior exposure to the SARS-CoV-2 virus. All patients were monitored for one year to assess the incidence of major adverse cardiovascular events (MACE). Additionally, baseline and follow-up echocardiography data were obtained with a minimum 3-month interval.
Results:
In comparison between two groups regarding to indices of CMR, left ventricular (LV) ejection fraction (p < 0.001), right ventricular (RV) ejection fraction (p < 0.001) were significantly lower in non-COVID group, and significant LV and RV systolic dysfunction were meaningfully lower in the COVID group. Extension of late gadolinium enhancement (LGE) was significantly greater in COVID group. Finally, the incidence of MACE and mean event-free survival did not have significant difference between two groups.
Conclusions:
Although CMR findings differed between the 2 groups, there was no significant difference in the risk of MACE or survival during one-year follow-up. Notably, LV and RV dysfunction were more prevalent in the non-COVID group, while extension of LGE was greater in the COVID group.
REFERENCES (34)
1.
Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA 2020; 324: 603-605.
2.
Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect 2021; 27: 258-263.
3.
Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med 2021; 27: 601-615.
4.
Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2023; 401: e21-e33. doi: 10.1016/S0140-6736(23)00810-3.
5.
Mahmoudi E, Mollazadeh R, Mansouri P, Keykhaei M, Mirshafiee S, Hedayat B, et al. Ventricular repolarization heterogeneity in patients with COVID‐19: original data, systematic review, and meta‐analysis. Clin Cardiol 2022; 45: 110-118.
6.
Huang L, Yao Q, Gu X, Wang Q, Ren L, Wang Y, et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet 2021; 398: 747-758.
7.
Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 1265-1273.
8.
Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020; 5: 802-810.
9.
Rajpal S, Tong MS, Borchers J, Zareba KM, Obarski TP, Simonetti OP, et al. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. JAMA Cardiol 2021; 6: 116-118.
10.
Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020; 20: 533-534.
11.
Raman B, Bluemke DA, Lüscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur Heart J 2022; 43: 1157-1172.
12.
Varpaei HA, Mohammadi M, Loni S, Hashemi-Amir SY. Anticoagulant Therapy Is a Contentious Issue in COVID-19 Patients. Arch Anesth Crit Care 2022; 8: 263-266.
13.
Ammirati E, Lupi L, Palazzini M, Hendren NS, Grodin JL, Cannistra-ci CV, et al. Prevalence, characteristics, and outcomes of COVID-19-associated acute myocarditis. Circulation 2022; 145: 1123-1139.
14.
Eslami M, Mollazadeh R, Mirshafiee S, Sehat P, Alizadeh F, Emkan-joo Z, et al. Postural orthostatic tachycardia syndrome and orthostatic hypotension post COVID-19. Infect Disord Drug Targets 2023; 23: e100622205846. DOI: 10.2174/1871526522666220610143504.
15.
Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 811-818.
16.
Lala A, Johnson KW, Januzzi JL, Russak AJ, Paranjpe I, Richter F, et al. Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection. J Am Coll Cardiol 2020; 76: 533-546.
17.
Weber B, Siddiqi H, Zhou G, Vieira J, Kim A, Rutherford H, et al. Relationship between myocardial injury during index hospitalization for SARS-CoV-2 infection and longer-term outcomes. J Am Heart Assoc 2022; 11: e022010. DOI: 10.1161/JAHA.121.022010.
18.
De Michieli L, Ola O, Knott JD, Akula A, Mehta RA, Hodge DO, et al. High-sensitivity cardiac troponin T for the detection of myocardial injury and risk stratification in COVID-19. Clin Chem 2021; 67: 1080-1089.
19.
Ammirati E, Frigerio M, Adler ED, Basso C, Birnie DH, Brambatti M, et al. Management of acute myocarditis and chronic inflammatory cardiomyopathy: an expert consensus document. Circ Heart Fail 2020; 13: e007405. DOI: 10.1161/CIRCHEARTFAILURE.120.007405.
20.
Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 2007; 116: 2216-2233.
21.
Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol 2018; 72: 3158-3176.
22.
Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 2007; 28: 1326-1333.
23.
Barone-Rochette G, Augier C, Rodière M, Quesada JL, Foote A, Bouvaist H, et al. Potentially simple score of late gadolinium enhancement cardiac MR in acute myocarditis outcome. J Magn Reson Imaging 2014; 40: 1347-1354.
24.
Georgiopoulos G, Figliozzi S, Sanguineti F, Aquaro GD, di Bella G, Stamatelopoulos K, et al. Prognostic impact of late gadolinium enhancement by cardiovascular magnetic resonance in myocarditis: a systematic review and meta-analysis. Circ Cardiovasc Imaging 2021; 14: e011492. DOI: 10.1161/CIRCIMAGING.120.011492.
25.
Gräni C, Eichhorn C, Bière L, Murthy VL, Agarwal V, Kaneko K, et al. Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. J Am Coll Cardiol 2017; 70: 1964-1976.
26.
Luetkens JA, Faron A, Isaak A, Dabir D, Kuetting D, Feisst A, et al. Comparison of original and 2018 Lake Louise criteria for diagnosis of acute myocarditis: results of a validation cohort. Radiol Cardiothorac Imaging 2019; 1: e190010. DOI: 10.1148/ryct.2019190010.
27.
Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al; American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the American Heart Association. Circulation 2002; 105: 539-542.
28.
Davis MG, Bobba A, Chourasia P, Gangu K, Shuja H, Dandachi D, et al. COVID-19 associated myocarditis clinical outcomes among hospitalized patients in the United States: a propensity matched analysis of national inpatient sample. Viruses 2022; 14: 2791. DOI: 10.3390/v14122791.
29.
Piccirillo F, Watanabe M, Di Sciascio G. Diagnosis, treatment and predictors of prognosis of myocarditis. A narrative review. Cardiovasc Pathol 2021; 54: 107362. DOI: 10.1016/j.carpath.2021.107362.
30.
Haberka M, Rajewska-Tabor J, Wojtowicz D, Jankowska A, Miszalski-Jamka K, Janus M, et al. Perimyocardial injury specific for SARS-CoV-2-induced myocarditis in comparison with non-COVID-19 myocarditis: a multicenter CMR study. Cardiovasc Imaging 2022; 15: 705-707.
31.
Kotecha T, Knight DS, Razvi Y, Kumar K, Vimalesvaran K, Thornton G, et al. Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance. Eur Heart J 2021; 42: 1866-1878.
32.
Hadley SM, Prakash A, Baker AL, de Ferranti SD, Newburger JW, Friedman KG, et al. Follow-up cardiac magnetic resonance in children with vaccine-associated myocarditis. Eur J Pediatr 2022; 181: 2879-2883.
33.
Fronza M, Thavendiranathan P, Karur GR, Abdel-Qadir H, Udell JA, Wald RM, et al. Cardiac MRI and clinical follow-up in COVID-19 vaccine-associated myocarditis. Radiology 2022; 304: E48-E49. doi: 10.1148/radiol.220802.
34.
Haberka M, Rajewska-Tabor J, Wojtowicz D, Jankowska A, Miszalski-Jamka K, Janus M, et al. A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: a multicenter cardiovascular magnetic resonance study. Kardiol Pol 2023; 81: 463-471.
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