Clinical and cardiac magnetic resonance findings in post-COVID patients referred for suspected myocarditis,Clinical Research in Cardiology

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Clinical and cardiac magnetic resonance findings in post-COVID patients referred for suspected myocarditis
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-08-26 , DOI: 10.1007/s00392-021-01929-5
Philipp Breitbart _{1,

2,

3} , Alexander Koch _{1,

3} , Marco Schmidt _{1,

3} , Annett Magedanz _{1,

3} , Edelgard Lindhoff-Last _{1,

3} , Thomas Voigtländer _{1,

3} , Axel Schmermund _{1,

3} , Rajendra H Mehta ₄ , Holger Eggebrecht _{1,

3}

Affiliation

Objectives

We assessed possible myocardial involvement in previously cardiac healthy post-COVID patients referred for persisting symptoms with suspected myocarditis.

Background

Prior studies suggested myocardial inflammation in patients with coronavirus-induced disease 2019 (COVID-19). However, the prevalence of cardiac involvement among COVID patients varied between 1.4 and 78%.

Methods

A total of 56 post-COVID patients without previous heart diseases were included consecutively into this study. All patients had positive antibody titers against SARS-CoV-2. Patients were referred for persistent symptoms such as chest pain/discomfort, shortness of breath, or intolerance to activity. All patients underwent standardized cardiac assessment including electrocardiogram (ECG), cardiac biomarkers, echocardiography, and cardiac magnetic resonance (CMR).

Results

56 Patients (46 ± 12 years, 54% females) presented 71 ± 66 days after their COVID-19 disease. In most patients, the course of COVID-19 was mild, with hospital treatment being necessary in five (9%). At presentation, patients most often reported persistent fatigue (75%), chest pain (71%), and shortness of breath (66%). Acute myocarditis was confirmed by T1/T2-weighed CMR and elevated NTpro-BNP levels in a single patient (2%). Left ventricular ejection fraction was 56% in this patient. Additional eight patients (14%) showed suspicious CMR findings, including myocardial edema without fibrosis (n = 3), or non-ischemic myocardial injury suggesting previous inflammation (n = 5). However, myocarditis could ultimately not be confirmed according to 2018 Lake Louise criteria; ECG, echo and lab findings were inconspicuous in all eight patients.

Conclusions

Among 56 post-COVID patients with persistent thoracic complaints final diagnosis of myocarditis could be confirmed in a single patient using CMR.

Graphic abstract

中文翻译：

COVID 后疑似心肌炎患者的临床和心脏磁共振检查结果

目标

我们评估了先前心脏健康的 COVID 后患者可能的心肌受累，这些患者因疑似心肌炎的持续症状而转诊。

背景

先前的研究表明，2019 年冠状病毒引起的疾病 (COVID-19) 患者存在心肌炎症。然而，COVID 患者中心脏受累的患病率在 1.4% 到 78% 之间变化。

方法

共有 56 名既往没有心脏病的 COVID 后患者被连续纳入本研究。所有患者的 SARS-CoV-2 抗体滴度均为阳性。患者因持续症状而被转诊，例如胸痛/不适、呼吸急促或对活动不耐受。所有患者均接受了标准化的心脏评估，包括心电图（ECG）、心脏生物标志物、超声心动图和心脏磁共振（CMR）。

结果

56 名患者（46 ± 12 岁，54% 女性）在感染 COVID-19 后 71 ± 66 天就诊。在大多数患者中，COVID-19 的病程较轻，有 5 人 (9%) 需要住院治疗。就诊时，患者最常报告持续疲劳（75%）、胸痛（71%）和呼吸急促（66%）。T1/T2 加权 CMR 和单个患者的 NTpro-BNP 水平升高证实了急性心肌炎 (2%)。该患者的左心室射血分数为 56%。另外 8 名患者 (14%) 表现出可疑的 CMR 发现，包括无纤维化的心肌水肿 ( n = 3)，或提示先前炎症的非缺血性心肌损伤 ( n = 5)。但根据 2018 年路易斯湖标准最终无法确诊心肌炎；所有 8 名患者的心电图、回声和实验室检查结果均不明显。