Early detection of myocardial involvement can be relevant in coronavirus disease 2019 (COVID-19) patients to timely target symptomatic treatment and decrease the occurrence of the cardiac sequelae of the infection. The aim of the present study was to assess the clinical value of cardiovascular magnetic resonance (CMR) in characterizing myocardial damage in active COVID-19 patients, through the correlation between qualitative and quantitative imaging biomarkers with clinical and laboratory evidence of myocardial injury. In this retrospective observational cohort study, we enrolled 27 patients with diagnosis of active COVID-19 and suspected cardiac involvement, referred to our institution for CMR between March 2020 and January 2021. Clinical and laboratory characteristics, including high sensitivity troponin T (hs-cTnT), and CMR imaging data were obtained. Relationships between CMR parameters, clinical and laboratory findings were explored. Comparisons were made with age-, sex- and risk factor–matched control group of 27 individuals, including healthy controls and patients without other signs or history of myocardial disease, who underwent CMR examination between January 2020 and January 2021. The median (IQR) time interval between COVID-19 diagnosis and CMR examination was 20 (13.5–31.5) days. Hs-cTnT values were collected within 24 h prior to CMR and resulted abnormally increased in 18 patients (66.6%). A total of 20 cases (74%) presented tissue signal abnormalities, including increased myocardial native T1 (n = 11), myocardial T2 (n = 14) and extracellular volume fraction (ECV) (n = 10), late gadolinium enhancement (LGE) (n = 12) or pericardial enhancement (n = 2). A CMR diagnosis of myocarditis was established in 9 (33.3%), pericarditis in 2 (7.4%) and myocardial infarction with non-obstructive coronary arteries in 3 (11.11%) patients. T2 mapping values showed a moderate positive linear correlation with Hs-cTnT (r = 0.58; p = 0.002). A high degree positive linear correlation between ECV and Hs-cTnT was also found (r 0.77; p < 0.001). CMR allows in vivo recognition and characterization of myocardial damage in a cohort of selected COVID-19 individuals by means of a multiparametric scanning protocol including conventional imaging and T1–T2 mapping sequences. Abnormal T2 mapping was the most commonly abnormality observed in our cohort and positively correlated with hs-cTnT values, reflecting the predominant edematous changes characterizing the active phase of disease.

中文翻译：

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T2 映射增加是活动性 COVID-19 中心肌受累的普遍影像生物标志物：一项心血管磁共振研究


早期发现心肌受累对于 2019 年冠状病毒病 (COVID-19) 患者至关重要，以便及时进行有针对性的对症治疗并减少感染引起的心脏后遗症的发生。本研究的目的是通过定性和定量成像生物标志物与心肌损伤的临床和实验室证据之间的相关性，评估心血管磁共振（CMR）在表征活动性COVID-19患者心肌损伤方面的临床价值。在这项回顾性观察队列研究中，我们入组了 27 名诊断为活动性 COVID-19 并疑似心脏受累的患者，并在 2020 年 3 月至 2021 年 1 月期间转诊至我们机构进行 CMR。临床和实验室特征，包括高敏肌钙蛋白 T (hs-cTnT) ），并获得了 CMR 成像数据。探讨了 CMR 参数、临床和实验室结果之间的关系。与年龄、性别和危险因素匹配的 27 人对照组进行比较，其中包括健康对照组和没有其他心肌疾病体征或病史的患者，这些患者在 2020 年 1 月至 2021 年 1 月期间接受了 CMR 检查。中位数 (IQR) COVID-19诊断与CMR检查之间的时间间隔为20（13.5-31.5）天。在 CMR 前 24 小时内收集 Hs-cTnT 值，结果有 18 名患者（66.6%）异常升高。共有20例（74%）出现组织信号异常，包括心肌天然T1（n = 11）、心肌T2（n = 14）和细胞外体积分数（ECV）（n = 10）增加、晚期钆增强（LGE） ) (n = 12) 或心包增强 (n = 2)。 9 例 (33.3%) 的 CMR 诊断为心肌炎，2 例 (7.3%) 为心包炎。4%）和 3 名（11.11%）患者发生非阻塞性冠状动脉心肌梗死。 T2 映射值显示与 Hs-cTnT 呈中度正线性相关（r = 0.58；p = 0.002）。还发现 ECV 和 Hs-cTnT 之间存在高度正线性相关（r 0.77；p < 0.001）。 CMR 可以通过多参数扫描协议（包括传统成像和 T1-T2 映射序列）对选定的 COVID-19 个体队列中的心肌损伤进行体内识别和表征。 T2 映射异常是我们队列中最常见的异常，与 hs-cTnT 值呈正相关，反映了疾病活动期的主要水肿变化特征。