Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement.

ABSTRACT

BACKGROUND: Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood. OBJECTIVES: The purpose of this study was to characterize myocardial injury in a multicenter cohort of patients with COVID-19 and suspected cardiac involvement referred for cardiac magnetic resonance (CMR). METHODS: This retrospective study consisted of 1,047 patients from 18 international sites with polymerase chain reaction-confirmed COVID-19 infection who underwent CMR. Myocardial injury was characterized as acute myocarditis, nonacute/nonischemic, acute ischemic, and nonacute/ischemic patterns on CMR. RESULTS: In this cohort, 20.9% of patients had nonischemic injury patterns (acute myocarditis 7.9%; nonacute/nonischemic 13.0%), and 6.7% of patients had ischemic injury patterns (acute ischemic 1.9%; nonacute/ischemic 4.8%). In a univariate analysis, variables associated with acute myocarditis patterns included chest discomfort (OR 2.00; 95% CI 1.17-3.40, P = 0.01), abnormal electrocardiogram (ECG) (OR 1.90; 95% CI 1.12-3.23; P = 0.02), natriuretic peptide elevation (OR 2.99; 95% CI 1.60-5.58; P = 0.0006), and troponin elevation (OR 4.21; 95% CI 2.41-7.36; P < 0.0001). Variables associated with acute ischemic patterns included chest discomfort (OR 3.14; 95% CI 1.04-9.49; P = 0.04), abnormal ECG (OR 4.06; 95% CI 1.10-14.92; P = 0.04), known coronary disease (OR 33.30; 95% CI 4.04-274.53; P = 0.001), hospitalization (OR 4.98; 95% CI 1.55-16.05; P = 0.007), natriuretic peptide elevation (OR 4.19; 95% CI 1.30-13.51; P = 0.02), and troponin elevation (OR 25.27; 95% CI 5.55-115.03; P < 0.0001). In a multivariate analysis, troponin elevation was strongly associated with acute myocarditis patterns (OR 4.98; 95% CI 1.76-14.05; P = 0.003). CONCLUSIONS: In this multicenter study of patients with COVID-19 with clinical suspicion for cardiac involvement referred for CMR, nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present.