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Cardiovascular magnetic resonance evaluation of soldiers after recovery from symptomatic SARS-CoV-2 infection: a case-control study of cardiovascular post-acute sequelae of SARS-CoV-2 infection (CV PASC).
Clark, Daniel E; Dendy, Jeffrey M; Li, Dan L; Crum, Kimberly; Dixon, Debra; George-Durrett, Kristen; Parikh, Amar P; Wassenaar, Jean W; Hughes, Sean G; Soslow, Jonathan H.
  • Clark DE; Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Daniel.e.clark@vumc.org.
  • Dendy JM; Vanderbilt University Medical Center, 2220 Pierce Avenue, 383 Preston Research Building, Nashville, TN, 37237, USA. Daniel.e.clark@vumc.org.
  • Li DL; Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Crum K; Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Dixon D; Thomas P. Graham Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
  • George-Durrett K; Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Parikh AP; Thomas P. Graham Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
  • Wassenaar JW; Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Hughes SG; Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Soslow JH; Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
J Cardiovasc Magn Reson ; 23(1): 106, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1455983
ABSTRACT

BACKGROUND:

Myocarditis is a potential complication after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and a known cause of sudden cardiac death. Given the athletic demands of soldiers, identification of myocarditis and characterization of post-acute sequelae of SARS-CoV-2 infection with cardiovascular symptoms (CV PASC) may be critical to guide return-to-service. This study sought to evaluate the spectrum of cardiac involvement among soldiers with cardiopulmonary symptoms in the late convalescent phase of recovery from SARS-CoV-2 compared to a healthy soldier control group, and to determine the rate of progression to CV PASC.

METHODS:

All soldiers referred for cardiovascular magnetic resonance (CMR) imaging for cardiopulmonary symptoms following COVID-19 were enrolled and matched by age, gender, and athletic phenotype 11 to soldiers undergoing CMR in the year prior to the first case of COVID-19 at our institution. Demographic, clinical, laboratory, and imaging parameters were compared between groups. The diagnosis of acute myocarditis was made using modified Lake Louise criteria. Wilcoxon rank sum and chi-squared tests were used for comparison of continuous and categorical variables, respectively.

RESULTS:

Fifty soldier cases and 50 healthy soldier controls were included. The median time from SARS-CoV-2 detection to CMR was 71 days. The majority of cases experienced moderate symptoms (N = 43, 86%), while only 10% required hospitalization. The right ventricular (RV) ejection fraction (RVEF) was reduced in soldier cases compared to controls (51.0% vs. 53.2%, p = 0.012). Four cases were diagnosed with myocarditis (8%), 1 (2%) was diagnosed with Takotsubo cardiomyopathy, and 1 (2%) had new biventricular systolic dysfunction of unclear etiology. Isolated inferior RV septal insertion late gadolinium enhancement (LGE) was present in 8 cases and 8 controls (16% vs. 24%, p = 0.09). Seven of the 19 (37%) cases that completed an intermediate-term follow-up survey reported CV PASC at a median of 139 days of follow-up. Two of the 7 soldiers (29%) with CV PASC had a pathological clinical diagnosis (myocarditis) on CMR.

CONCLUSIONS:

Cardiovascular pathology was diagnosed in 6 symptomatic soldiers (12%) after recovery from SARS-CoV-2, with myocarditis found in 4 (8%). RVEF was reduced in soldier cases compared to controls. CV PASC occurred in over one-third of soldiers surveyed, but did not occur in any soldiers with asymptomatic acute SARS-CoV-2 infection.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Military Personnel / Myocarditis Type of study: Cohort study / Diagnostic study / Etiology study / Experimental Studies / Observational study / Prognostic study / Qualitative research / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: J Cardiovasc Magn Reson Journal subject: Vascular Diseases / Cardiology / Diagnostic Imaging Year: 2021 Document Type: Article Affiliation country: S12968-021-00798-1

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Military Personnel / Myocarditis Type of study: Cohort study / Diagnostic study / Etiology study / Experimental Studies / Observational study / Prognostic study / Qualitative research / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: J Cardiovasc Magn Reson Journal subject: Vascular Diseases / Cardiology / Diagnostic Imaging Year: 2021 Document Type: Article Affiliation country: S12968-021-00798-1