ABSTRACT
BACKGROUND: Myocardial scars detected by cardiac magnetic resonance imaging (CMR) after COVID-19 have caused concerns regarding potential long-term cardiovascular consequences. Therefore, we wanted to investigate cardiopulmonary functioning in patients with versus without COVID-19-related myocardial scars. METHODS: In this prospective cohort study, CMR was performed approximately 6 months after moderate-to-severe COVID-19. Before (~3 months post-COVID) and after (~12 months post-COVID) the CMR, patients underwent extensive cardiopulmonary testing with cardiopulmonary exercise tests (CPET), 24-hour ECG, echocardiography, and assessment of dyspnea. We excluded participants with overt heart failure. RESULTS: 49 patients with post-COVID CMR had available cardiopulmonary tests at 3 and 12 months after the index hospitalization. Nine (18%) patients had small LGE-detected myocardial scars. Patients with myocardial scars were older (63.2±13.2 vs 56.2±13.2 years) and more frequently men (89% vs 55%) compared to those without scars. Echocardiographic measurements, arrhythmic burden, and CPET results were similar in patients with and without scars, i.e. peak oxygen uptake: 82.1±11.5% vs 76.3±22.5% of predicted (p=0.46). There were no significant associations between myocardial scar and longitudinal changes in cardiopulmonary function from 3 to 12 months. CONCLUSION: Our findings imply that the presence of minor myocardial scars has limited clinical significance with respect to cardiopulmonary function after COVID-19. .
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) may cause myocardial injury and myocarditis, and reports of persistent cardiac pathology after COVID-19 have raised concerns of long-term cardiac consequences. We aimed to assess the presence of abnormal cardiovascular resonance imaging (CMR) findings in patients recovered from moderate-to-severe COVID-19, and its association with markers of disease severity in the acute phase. METHODS: Fifty-eight (49%) survivors from the prospective COVID MECH study, underwent CMR median 175 [IQR 105-217] days after COVID-19 hospitalization. Abnormal CMR was defined as left ventricular ejection fraction (LVEF) <50% or myocardial scar by late gadolinium enhancement. CMR indices were compared to healthy controls (n = 32), and to circulating biomarkers measured during the index hospitalization. RESULTS: Abnormal CMR was present in 12 (21%) patients, of whom 3 were classified with major pathology (scar and LVEF <50% or LVEF <40%). There was no difference in the need of mechanical ventilation, length of hospital stay, and vital signs between patients with vs without abnormal CMR after 6 months. Severe acute respiratory syndrome coronavirus 2 viremia and concentrations of inflammatory biomarkers during the index hospitalization were not associated with persistent CMR pathology. Cardiac troponin T and N-terminal pro-B-type natriuretic peptide concentrations on admission, were higher in patients with CMR pathology, but these associations were not significant after adjusting for demographics and established cardiovascular disease. CONCLUSIONS: CMR pathology 6 months after moderate-to-severe COVID-19 was present in 21% of patients and did not correlate with severity of the disease. Cardiovascular biomarkers during COVID-19 were higher in patients with CMR pathology, but with no significant association after adjusting for confounders. TRIAL REGISTRATION: COVID MECH Study ClinicalTrials.gov Identifier: NCT04314232.