BACKGROUND AND PURPOSE:

• Puntmann et al. (JAMA Cardiology, 2020) examined the presence of myocardial injury in unselected patients recently recovered from COVID-19 illness

METHODS:

• Prospective cohort study (April and June, 2020)
• Setting
  • University Hospital system
• Participants
  • Patients recently recovered from COVID-19 (RT-PCR confirmed)
• Study design
  • The authors obtained 
    • Demographic characteristics | Cardiac blood markers | Cardiovascular magnetic resonance (CMR) imaging
  • Outcomes in the following groups were compared to age-matched and sex-matched controls
    • Healthy volunteers
    • Risk factor-matched patients

RESULTS:

• 100 patients recovered from COVID-19 were included
  • Median (IQR) age: 49 years (45 to 53) |  53% male
  • 67% recovered from COVID-19 at home | 33% were hospitalized
• 50 healthy volunteers and 57 risk factor-matched patients were used for comparisons         
• Median (IQR) time between COVID-19 diagnosis and CMR: 71 (64 to 92) days
• At the time of CMR, high-sensitivity troponin T (hsTnT) was
  • Detectable (3 pg/mL or greater): 71% of recovered patients
  • Significantly elevated (13.9 pg/mL or greater): 5%
• Compared with healthy controls and risk factor–matched controls, patients recently recovered from COVID-19 had
  • Lower left ventricular ejection fraction
  • Higher left ventricle volumes
  • Higher left ventricle mass
• 78% of recovered patients had abnormal CMR results (native T1 can detect focal and diffuse disease processes, while native T2 provides an estimate of free tissue water content; See ‘Learn More – Primary Sources’ section for more on T1 and T2 mapping)
  • Raised myocardial native T1: 73 patients
  • Raised myocardial native T2: 60
  • Myocardial late gadolinium enhancement: 32
  • Pericardial enhancement: 22
• Patients who recovered at home vs hospital had
  • Significant native T1 mapping and hsTnT changes
  • No significant difference in T2 mapping
• Native T1, T2 and hsTnT measurements were not correlated with time from COVID-19 diagnosis
• Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation
• The measures with the best discriminatory ability to detect COVID-19 related myocardial pathology were native T1 and T2

CONCLUSION:

• 78% of patients recovered from COVID-19 in this study showed cardiac involvement on CMR
• The authors state that cardiac involvement occurred

…irrespective of preexisting conditions, the severity and overall course of the COVID-19 presentation, the time from the original diagnosis, or the presence of cardiac symptoms

The most prevalent abnormality was myocardial inflammation (defined as abnormal native T1 and T2 measures)

Learn More – Primary Sources:

Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)

Myocardial T1 and T2 Mapping: Techniques and Clinical Applications

Related ObG Topics:

Cardiac Injury: A Feature of COVID-19

COVID-19 and Coagulopathy

COVID-19 and Coagulopathy: ISTH Issues Guidance on Diagnosis and Management