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Jain SS, Anderson SA, Steele JM, Wilson HC, Muniz JC, Soslow JH, Beroukhim RS, Maksymiuk V, Jacquemyn X, Frosch OH, Fonseca B, Harahsheh AS, Buddhe S, Ashwath RC, Thacker D, Maskatia SA, Misra N, Su JA, Siddiqui S, Vaiyani D, Vaikom-House AK, Campbell MJ, Klein J, Huang S, Mathis C, Cornicelli MD, Sharma M, Nagaraju L, Ang JY, Uppu SC, Ramachandran P, Patel JK, Han F, Mandell JG, Akam-Venkata J, DiLorenzo MP, Brumund M, Bhatla P, Eshtehardi P, Mehta K, Glover K, Dove ML, Aldawsari KA, Kumar A, Barfuss SB, Dorfman AL, Minocha PK, Yonts AB, Schauer J, Cheng AL, Robinson JD, Powell Z, Srivastava S, Chelliah A, Sanil Y, Hernandez LE, Gaur L, Antonchak M, Johnston M, Reich JD, Nair N, Drugge ED, Grosse-Wortmann L. Cardiac manifestations and outcomes of COVID-19 vaccine-associated myocarditis in the young in the USA: longitudinal results from the Myocarditis After COVID Vaccination (MACiV) multicenter study. EClinicalMedicine 2024; 76:102809. [PMID: 39290640 PMCID: PMC11406334 DOI: 10.1016/j.eclinm.2024.102809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024] Open
Abstract
Background We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). Methods In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The primary outcome was presence of myocardial injury as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Findings Patients with C-VAM were predominantly white (67%) adolescent males (91%, 15.7 ± 2.8 years). Their initial clinical course was more likely to be mild (80% vs. 23%, p < 0.001) and cardiac dysfunction was less common (17% vs. 68%, p < 0.0001), compared to MIS-C. In contrast, LGE on CMR was more prevalent in C-VAM (82% vs. 16%, p < 0.001). The probability of LGE was higher in males (OR 3.28 [95% CI: 0.99, 10.6, p = 0.052]), in older patients (>15 years, OR 2.74 [95% CI: 1.28, 5.83, p = 0.009]) and when C-VAM occurred after the first or second dose as compared to the third dose of mRNA vaccine. Mid-term clinical outcomes of C-VAM at a median follow-up of 178 days (IQR 114-285 days) were reassuring. No cardiac deaths or heart transplantations were reported until the time of submission of this report. LGE persisted in 60% of the patients at follow up. Interpretation Myocardial injury at initial presentation and its persistence at follow up, despite a mild initial course and favorable mid-term clinical outcome, warrants continued clinical surveillance and long-term studies in affected patients with C-VAM. Funding The U.S. Food and Drug Administration.
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Affiliation(s)
- Supriya S Jain
- Department of Pediatrics, Division of Cardiology, New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | | | | | - Hunter C Wilson
- Emory University School of Medicine, Sibley Heart Center, Atlanta, GA, USA
| | | | | | | | - Victoria Maksymiuk
- Department of Pediatrics, Division of Cardiology, New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Xander Jacquemyn
- Department of Pediatrics, Johns Hopkins School of Medicine, Helen B. Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Olivia H Frosch
- University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | - Ashraf S Harahsheh
- Children's National Hospital and the George Washington University School of Medicine & Health Sciences, WA, USA
| | | | - Ravi C Ashwath
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Deepika Thacker
- Nemours Children's Health/Nemours Cardiac Center, Wilmington, DE, USA
| | | | - Nilanjana Misra
- Cohen Children's Medical Center, Northwell Health, New York, USA
| | - Jennifer A Su
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | - Danish Vaiyani
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - M Jay Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University, Durham, NC, USA
| | - Jared Klein
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Sihong Huang
- Betz Congenital Health Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | | | | | - Madhu Sharma
- The Children's Hospital at Montefiore Bronx, New York, USA
| | | | | | - Santosh C Uppu
- The University of Texas Health Science Center, Children's Heart Institute, Houston, TX, USA
| | | | | | - Frank Han
- University of Illinois College of Medicine, Peoria, IL, USA
| | - Jason G Mandell
- University of Rochester-Golisano Children's Hospital, Rochester, NY, USA
| | | | | | - Michael Brumund
- Louisiana State University Health Sciences Center, Children's Hospital New Orleans, New Orleans, LA, USA
| | - Puneet Bhatla
- NYU Langone Health, Hassenfeld Children's Hospital, New York, NY, USA
| | | | - Karina Mehta
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University-Doernbecher Children's Hospital, Portland, OR, USA
| | | | - Matthew L Dove
- Emory University School of Medicine, Sibley Heart Center, Atlanta, GA, USA
| | | | - Anupam Kumar
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Spencer B Barfuss
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Adam L Dorfman
- University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | - Alexandra B Yonts
- Children's National Hospital and the George Washington University School of Medicine & Health Sciences, WA, USA
| | | | - Andrew L Cheng
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Joshua D Robinson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Zachary Powell
- The University of Oklahoma Health Science Oklahoma City, Oklahoma, USA
| | | | | | - Yamuna Sanil
- Riley Hospital for Children, Indianapolis, IN, USA
| | | | - Lasya Gaur
- Department of Pediatrics, Johns Hopkins School of Medicine, Helen B. Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Antonchak
- NYU Langone Health, Hassenfeld Children's Hospital, New York, NY, USA
| | - Marla Johnston
- Louisiana State University Health Sciences Center, Children's Hospital New Orleans, New Orleans, LA, USA
| | | | - Narayan Nair
- The U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Elizabeth D Drugge
- Department of Pediatrics, Division of Cardiology, New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University-Doernbecher Children's Hospital, Portland, OR, USA
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Rico-Mesa JS, Haloot J, Anupama BK, Atluri S, Liu J, Khalid U. The Role and Implications of COVID-19 in Incident and Prevalent Heart Failure. Curr Heart Fail Rep 2024; 21:485-497. [PMID: 39042238 DOI: 10.1007/s11897-024-00677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE OF REVIEW This review examines the pathophysiological interactions between COVID-19 and heart failure, highlighting the exacerbation of heart failure in COVID-19 patients. It focuses on the complex mechanisms driving worse outcomes in these patients. RECENT FINDINGS Patients with pre-existing heart failure experience more severe symptoms and higher mortality rates due to mechanisms such as cytokine storms, myocardial infarction, myocarditis, microvascular dysfunction, thrombosis, and stress cardiomyopathy. Elevated biomarkers like troponin and natriuretic peptides correlate with severe disease. Long-term cardiovascular risks for COVID-19 survivors include increased incidence of heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock. COVID-19 significantly impacts patients with pre-existing heart failure, leading to severe symptoms and higher mortality. Elevated cardiac biomarkers are indicators of severe disease. Acute and long-term cardiovascular complications are common, calling for ongoing research into targeted therapies and improved management strategies to better prevent, diagnose, and treat heart failure in the context of COVID-19.
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Affiliation(s)
| | - Justin Haloot
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - B K Anupama
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Suman Atluri
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jing Liu
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Umair Khalid
- Department of Cardiology, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
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Popovic M, Cvetic V, Popadic V, Ilic K, Radojevic A, Klasnja A, Milic N, Rajovic N, Lasica R, Gostiljac D, Klasnja S, Mahmutovic E, Zdravkovic M. The Correlation between Cardiac Magnetic Resonance Findings and Post-COVID-19: The Impact of Myocardial Injury on Quality of Life. Diagnostics (Basel) 2024; 14:1937. [PMID: 39272722 PMCID: PMC11394307 DOI: 10.3390/diagnostics14171937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND In the post-COVID-19 era, there is growing concern regarding its impact on cardiovascular health and the following effects on the overall quality of life of affected individuals. This research seeks to investigate cardiac magnetic resonance (CMR) findings following COVID-19 and their impact on the quality of life of affected individuals. METHODS An observational, cross-sectional study was conducted in consecutive patients with persistent cardiovascular symptoms after COVID-19 who were referred to CMR due to suspected myocardial injury. In addition, patients completed a questionnaire about symptoms and the quality of life during the post-COVID-19 period. RESULTS In this study, 85 patients were included. The study population consisted of patients with a mean age of 42.5 ± 13.4 years, predominantly women, who made up 69.4% of the study population, while men made up 30.6%. CMR findings showed non-ischemic myocardial injury in 78.8% of patients and myocardial edema in 14.1% of patients. Late pericardial enhancement was present in 40% of patients and pericardial effusion in 51.8% of patients. Pericardial effusion (p = 0.001) was more prevalent in patients who reported more pronounced symptoms in the post-COVID-19 period compared to the acute infection phase. Predictors of lower quality of life in the post-COVID-19 period were the presence of irregular heartbeat (p = 0.039), cardiovascular problems that last longer than 12 weeks (p = 0.018), and the presence of pericardial effusion (p = 0.037). CONCLUSION Acute myocarditis was observed in a minority of patients after COVID-19, while non-ischemic LGE pattern and pericardial effusion were observed in the majority. Quality of life was worse during the post-COVID-19 period in patients with CMR abnormalities, primarily in patients with pericardial effusion. Also, irregular heartbeat, cardiovascular symptoms that last longer than 12 weeks, as well as pericardial effusion were independent predictors of lower quality of life during the post-COVID-19 period.
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Affiliation(s)
- Maja Popovic
- Department for Radiology, University Hospital Medical Center Bežanijska kosa, 11000 Belgrade, Serbia
| | - Vladimir Cvetic
- Department for Cardiovascular Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Viseslav Popadic
- Department for Cardiology, University Hospital Medical Center Bežanijska kosa, 11000 Belgrade, Serbia
| | - Kristina Ilic
- Department for Radiology, University Hospital Medical Center Bežanijska kosa, 11000 Belgrade, Serbia
| | - Aleksandra Radojevic
- Department for Cardiology, University Hospital Medical Center Bežanijska kosa, 11000 Belgrade, Serbia
| | - Andrea Klasnja
- Department for Cardiology, University Hospital Medical Center Bežanijska kosa, 11000 Belgrade, Serbia
| | - Natasa Milic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Nina Rajovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ratko Lasica
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Drasko Gostiljac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Slobodan Klasnja
- Department for Cardiology, University Hospital Medical Center Bežanijska kosa, 11000 Belgrade, Serbia
| | | | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department for Cardiology, University Hospital Medical Center Bežanijska kosa, 11000 Belgrade, Serbia
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Vidula MK, Han Y. Medium-Term Outcomes of Hospitalized COVID-19 Patients With Myocardial Injury: Cautiously Optimistic. JACC Cardiovasc Imaging 2024:S1936-878X(24)00302-4. [PMID: 39207332 DOI: 10.1016/j.jcmg.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Mahesh K Vidula
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuchi Han
- Cardiovascular Division, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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Rafiee MJ, Friedrich MG. MRI of cardiac involvement in COVID-19. Br J Radiol 2024; 97:1367-1377. [PMID: 38656976 PMCID: PMC11256941 DOI: 10.1093/bjr/tqae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/20/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024] Open
Abstract
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to a diverse pattern of myocardial injuries, including myocarditis, which is linked to adverse outcomes in patients. Research indicates that myocardial injury is associated with higher mortality in hospitalized severe COVID-19 patients (75.8% vs 9.7%). Cardiovascular Magnetic Resonance (CMR) has emerged as a crucial tool in diagnosing both ischaemic and non-ischaemic myocardial injuries, providing detailed insights into the impact of COVID-19 on myocardial tissue and function. This review synthesizes existing studies on the histopathological findings and CMR imaging patterns of myocardial injuries in COVID-19 patients. CMR imaging has revealed a complex pattern of cardiac damage in these patients, including myocardial inflammation, oedema, fibrosis, and ischaemic injury, due to coronary microthrombi. This review also highlights the role of LLC criteria in diagnosis of COVID-related myocarditis and the importance of CMR in detecting cardiac complications of COVID-19 in specific groups, such as children, manifesting multisystem inflammatory syndrome in children (MIS-C) and athletes, as well as myocardial injuries post-COVID-19 infection or following COVID-19 vaccination. By summarizing existing studies on CMR in COVID-19 patients and highlighting ongoing research, this review contributes to a deeper understanding of the cardiac impacts of COVID-19. It emphasizes the effectiveness of CMR in assessing a broad spectrum of myocardial injuries, thereby enhancing the management and prognosis of patients with COVID-19 related cardiac complications.
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Affiliation(s)
- Moezedin Javad Rafiee
- Department of Medicine, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada
| | - Matthias G Friedrich
- Department of Medicine, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec H4A3J1, Canada
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Albrecht JS, Greenshields JT, Smart S, Law IH, Rink LR, Daniels CJ, Rajpal S, Chung EH, Jeudy J, Kovacs R, Womack J, Esopenko C, Bosha P, Terrin M, Rosenthal GL. Results From the Big Ten COVID-19 Cardiac Registry: Impact of SARS-COV-2 on Myocardial Involvement. Clin J Sport Med 2024:00042752-990000000-00206. [PMID: 38975888 DOI: 10.1097/jsm.0000000000001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE COVID-19 has been associated with myocardial involvement in collegiate athletes. The first report from the Big Ten COVID-19 Cardiac Registry (Registry) was an ecological study that reported myocarditis in 37 of 1597 athletes (2.3%) based on local clinical diagnosis. Our objective was to assess the relationship between athlete and clinical characteristics and myocardial involvement. DESIGN Cross-sectional study. SETTING We analyzed data from 1218 COVID-19 positive Big Ten collegiate athletes who provided informed consent to participate in the Registry. PARTICIPANTS 1218 athletes with a COVID-19-positive PCR test before June 1, 2021. ASSESSMENT OF INDEPENDENT VARIABLES Demographic and clinical characteristics of athletes were obtained from the medical record. MAIN OUTCOME MEASURES Myocardial involvement was diagnosed based on local clinical, cardiac magnetic resonance (CMR), electrocardiography, troponin assay, and echocardiography. We assessed the association of clinical factors with myocardial involvement using logistic regression and estimated the area under the receiver operating characteristic (ROC) curve. RESULTS 25 of 1218 (2.0%) athletes met criteria for myocardial involvement. The logistic regression model used to predict myocardial involvement contained indicator variables for chest pain, new exercise intolerance, abnormal echocardiogram (echo), and abnormal troponin. The area under the ROC curve for these indicators was 0.714. The presence of any of these 4 factors in a collegiate athlete who tested positive for COVID-19 would capture 55.6% of cases. Among noncases without missing data, 86.9% would not be flagged for possible myocardial involvement. CONCLUSION Myocardial involvement was infrequent. We predicted case status with good specificity but deficient sensitivity. A diagnostic approach for myocardial involvement based exclusively on symptoms would be less sensitive than one based on symptoms, echo, and troponin level evaluations. Abnormality of any of these evaluations would be an indication for CMR.
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Affiliation(s)
- Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | | | - Suzanne Smart
- Division of Cardiology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Ian H Law
- University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Larry R Rink
- Indiana University School of Medicine, Bloomington, IN
| | - Curt J Daniels
- Division of Cardiology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Saurabh Rajpal
- Division of Cardiology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | - Jason Womack
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Philip Bosha
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, State College, PA; and
| | - Michael Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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Raisi-Estabragh Z. Dispelling concerns: the mild nature of coronavirus disease 2019 vaccine-related myocarditis. J Cardiovasc Magn Reson 2024; 26:101044. [PMID: 38729578 PMCID: PMC11129083 DOI: 10.1016/j.jocmr.2024.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.
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Bhatt N, Orbach A, Biswas L, Strauss BH, Connelly K, Ghugre NR, Wright GA, Roifman I. Evaluating a novel accelerated free-breathing late gadolinium enhancement imaging sequence for assessment of myocardial injury. Magn Reson Imaging 2024; 108:40-46. [PMID: 38309379 DOI: 10.1016/j.mri.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Cardiac magnetic resonance imaging (MRI), including late gadolinium enhancement (LGE), plays an important role in the diagnosis and prognostication of ischemic and non-ischemic myocardial injury. Conventional LGE sequences require patients to perform multiple breath-holds and require long acquisition times. In this study, we compare image quality and assessment of myocardial LGE using an accelerated free-breathing sequence to the conventional standard-of-care sequence. METHODS In this prospective cohort study, a total of 41 patients post Coronavirus 2019 (COVID-19) infection were included. Studies were performed on a 1.5 Tesla scanner with LGE imaging acquired using a conventional inversion recovery rapid gradient echo (conventional LGE) sequence followed by the novel accelerated free-breathing (FB-LGE) sequence. Image quality was visually scored (ordinal scale from 1 to 5) and compared between conventional and free-breathing sequences using the Wilcoxon rank sum test. Presence of per-segment LGE was identified according to the American Heart Association 16-segment myocardial model and compared across both conventional LGE and FB-LGE sequences using a two-sided chi-square test. The perpatient LGE extent was also evaluated using both sequences and compared using the Wilcoxon rank sum test. Interobserver variability in detection of per-segment LGE and per-patient LGE extent was evaluated using Cohen's kappa statistic and interclass correlation (ICC), respectively. RESULTS The mean acquisition time for the FB-LGE sequence was 17 s compared to 413 s for the conventional LGE sequence (P < 0.001). Assessment of image quality was similar between both sequences (P = 0.19). There were no statistically significant differences in LGE assessed using the FB-LGE versus conventional LGE on a per-segment (P = 0.42) and per-patient (P = 0.06) basis. Interobserver variability in LGE assessment for FB-LGE was good for per-segment (= 0.71) and per-patient extent (ICC = 0.92) analyses. CONCLUSIONS The accelerated FB-LGE sequence performed comparably to the conventional standard-of-care LGE sequence in a cohort of patients post COVID-19 infection in a fraction of the time and without the need for breath-holding. Such a sequence could impact clinical practice by increasing cardiac MRI throughput and accessibility for frail or acutely ill patients unable to perform breath-holding.
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Affiliation(s)
- Nitish Bhatt
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ady Orbach
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Labonny Biswas
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bradley H Strauss
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kim Connelly
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Nilesh R Ghugre
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Graham A Wright
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Idan Roifman
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Gröschel J, Grassow L, van Dijck P, Bhoyroo Y, Blaszczyk E, Schulz-Menger J. Trajectories of functional and structural myocardial parameters in post-COVID-19 syndrome-insights from mid-term follow-up by cardiovascular magnetic resonance. Front Cardiovasc Med 2024; 11:1357349. [PMID: 38628318 PMCID: PMC11018885 DOI: 10.3389/fcvm.2024.1357349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Myocardial tissue alterations in patients with post-Coronavirus disease 2019 syndrome (PCS) are often subtle and mild. Reports vary in the prevalence of non-ischemic and ischemic injuries as well as the extent of ongoing myocardial inflammation. The exact relevance of these myocardial alterations is not fully understood. This study aimed at describing the trajectories of myocardial alterations in PCS patients by mid-term follow-up with cardiovascular magnetic resonance (CMR). Methods This study entails a retrospective analysis of symptomatic PCS patients referred for follow-up CMR between August 2020 and May 2023 due to mildly affected or reduced left or right ventricular function (LV and RV, respectively) and structural myocardial alterations, e.g., focal and diffuse fibrosis, on baseline scans. Follow-up CMR protocol consisted of cine images and full coverage native T1 and T2 mapping. Baseline and follow-up scans were compared using t-tests or Wilcoxon tests. Post-hoc analysis was carried out in a subgroup based on the change of LV stroke volume (SV) between scans. Results In total, 43 patients [median age (interquartile range) 46 (37-56) years, 33 women] received follow-ups 347 (167-651) days after initial diagnosis. A decrease in symptoms was recorded on follow-ups (p < 0.03) with 23 patients being asymptomatic at follow-ups [symptomatic at baseline 43/43 (100%) vs. symptomatic at follow-up 21/43 (49%), p < 0.001]. Functional improvement was noted for LV-SV [83.3 (72.7-95.0) vs. 84.0 (77.0-100.3) ml; p = 0.045], global radial [25.3% (23.4%-27.9%) vs. 27.4% (24.4%-33.1%); p < 0.001], and circumferential strains [-16.5% (-17.5% to -15.6%) vs. -17.2% (-19.5% to -16.1%); p < 0.001]. In total, 17 patients had an LV-SV change >10% on follow-up scans (5 with a decrease and 12 with an increase), with LV-SV, RV-SV, and global longitudinal strain being discriminatory variables on baseline scans (p = 0.01, 0.02, and 0.04, respectively). T1- or T2-analysis revealed no changes, remaining within normal limits. Conclusion Symptomatic load as well as blood pressures decreased on follow-up. CMR did not detect significant changes in tissue parameters; however, volumetric, specifically LV-SV, and deformation indexes improved during mid-term follow-up.
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Affiliation(s)
- Jan Gröschel
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute Berlin, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Leonhard Grassow
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Phillip van Dijck
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Deutsches Herzzentrum der Charité—Medical Heart Center of Charité and German Heart Institute Berlin, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Yashraj Bhoyroo
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
| | - Edyta Blaszczyk
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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10
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Talib N, Fronza M, Marschner CA, Thavendiranathan P, Karur GR, Hanneman K. Cardiovascular magnetic resonance imaging and clinical follow-up in patients with clinically suspected myocarditis after COVID-19 vaccination. J Cardiovasc Magn Reson 2024; 26:101036. [PMID: 38479457 PMCID: PMC11004989 DOI: 10.1016/j.jocmr.2024.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The purpose of this study was to evaluate cardiovascular magnetic resonance (CMR) findings and their relationship to longer-term clinical outcomes in patients with suspected myocarditis following coronavirus disease 2019 (COVID-19) vaccination. METHODS Consecutive adult patients who underwent clinically indicated CMR for evaluation of suspected myocarditis following messenger ribonucleic acid (mRNA)-based COVID-19 vaccination at a single center between 2021 and 2022 were retrospectively evaluated. Patients were classified based on the revised Lake Louise criteria for T1-based abnormalities (late gadolinium enhancement [LGE] or high T1 values) and T2-based abnormalities (regional T2-hyperintensity or high T2 values). RESULTS Eighty-nine patients were included (64% [57/89] male, mean age 34 ± 13 years, 38% [32/89] mRNA-1273, and 62% [52/89] BNT162b2). On baseline CMR, 42 (47%) had at least one abnormality; 25 (28%) met both T1- and T2-criteria; 17 (19%) met T1-criteria but not T2-criteria; and 47 (53%) did not meet either. The interval between vaccination and CMR was shorter in those who met T1- and T2-criteria (28 days, IQR 8-69) compared to those who met T1-criteria only (110 days, IQR 66-255, p < 0.001) and those who did not meet either (120 days, interquartile range (IQR) 80-252, p < 0.001). In the subset of 21 patients who met both T1- and T2-criteria at baseline and had follow-up CMR, myocardial edema had resolved and left ventricular ejection fraction had normalized in all at median imaging follow-up of 214 days (IQR 132-304). However, minimal LGE persisted in 10 (48%). At median clinical follow-up of 232 days (IQR 156-405, n = 60), there were no adverse cardiac events. However, mild cardiac symptoms persisted in 7 (12%). CONCLUSION In a cohort of patients who underwent clinically indicated CMR for suspected myocarditis following COVID-19 vaccination, 47% had at least one abnormality at baseline CMR. Detection of myocardial edema was associated with the timing of CMR after vaccination. There were no adverse cardiac events. However, minimal LGE persisted in 48% at follow-up.
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Affiliation(s)
- Norain Talib
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Matteo Fronza
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Constantin Arndt Marschner
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gauri Rani Karur
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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11
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Nguyen ET, Ordovas K, Herbst P, Kozor R, Ng MY, Natale L, Nijveldt R, Salgado R, Sanchez F, Shah D, Stojanovska J, Valente AM, Westwood M, Plein S. Competency based curriculum for cardiovascular magnetic resonance: A position statement of the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Magn Reson 2023; 26:100006. [PMID: 38215698 PMCID: PMC11211229 DOI: 10.1016/j.jocmr.2023.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 01/14/2024] Open
Abstract
This position statement guides cardiovascular magnetic resonance (CMR) imaging program directors and learners on the key competencies required for Level II and III CMR practitioners, whether trainees come from a radiology or cardiology background. This document is built upon existing curricula and was created and vetted by an international panel of cardiologists and radiologists on behalf of the Society for Cardiovascular Magnetic Resonance (SCMR).
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Affiliation(s)
- Elsie T Nguyen
- University Medical Imaging Toronto, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada.
| | | | - Phil Herbst
- Cardiology, Stellenbosch University, South Africa
| | - Rebecca Kozor
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Division Chief of Cardiac Imaging, HKU-Shenzhen Hospital, China
| | | | - Robin Nijveldt
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Rodrigo Salgado
- Antwerp University Hospital and University of Antwerp, Belgium; Dept. of Radiology, Holy Heart Lier, Belgium
| | - Felipe Sanchez
- Hospital Barros Luco Trudeau - Clinica Santa Maria, Santiago, Chile
| | - Dipan Shah
- Division of Cardiovascular Imaging, Houston, TX, USA
| | | | - Anne Marie Valente
- Harvard Medical School, Boston Children's Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Westwood
- Centre for Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Sven Plein
- British Heart Foundation Professor of Cardiovascular Imaging, University of Leeds, United Kingdom
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12
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Gyöngyösi M, Hasimbegovic E, Han E, Zlabinger K, Spannbauer A, Riesenhuber M, Hamzaraj K, Bergler-Klein J, Hengstenberg C, Kammerlander A, Kastl S, Loewe C, Beitzke D. Improvement of Symptoms and Cardiac Magnetic Resonance Abnormalities in Patients with Post-Acute Sequelae of SARS-CoV-2 Cardiovascular Syndrome (PASC-CVS) after Guideline-Oriented Therapy. Biomedicines 2023; 11:3312. [PMID: 38137533 PMCID: PMC10742066 DOI: 10.3390/biomedicines11123312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiac magnetic resonance (CMR) studies reported CMR abnormalities in patients with mild-moderate SARS-CoV-2 infection, suggesting ongoing myocardial inflammation. Patients (n = 278, 43 ± 13 years, 70.5% female) with post-acute sequelae of SARS-CoV-2 cardiovascular syndrome (PASC-CVS) were included prospectively into the Vienna POSTCOV Registry between March 2021 and March 2023 (clinicaltrials.gov NCT05398952). Clinical, laboratory, and CMR findings were recorded. Patients with abnormal CMR results were classified into isolated chronic pericardial (with/without pleural) effusion, isolated cardiac function impairment, or both (myopericarditis) groups. Medical treatment included a nonsteroidal anti-inflammatory agent (NSAID) for pericardial effusion and a condition-adapted maximal dose of heart failure (HF) treatment. Three months after medical therapy, clinical assessment and CMR were repeated in 82 patients. Laboratory analyses revealed normal hematological, inflammatory, coagulation, and cardiac biomarkers. CMR abnormalities were found in 155 patients (55.8%). Condition-adapted HF treatment led to a significant increase in the left ventricular ejection fraction (LVEF) in patients with initially reduced LVEF (from 49 ± 5% to 56 ± 4%, p = 0.009, n = 25). Low-moderate doses of NSAIDs for 3 months significantly reduced pericardial effusion (from 4/3;5.75/mm to 2/0;3/mm, median/interquartile ranges/p < 0.001, n = 51). Clinical symptoms improved markedly with a decrease in CMR abnormalities, which might be attributed to the maintenance of NSAID and HF medical treatment for PASC-CVS.
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Affiliation(s)
- Mariann Gyöngyösi
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Ena Hasimbegovic
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Emilie Han
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Katrin Zlabinger
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Andreas Spannbauer
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Martin Riesenhuber
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Kevin Hamzaraj
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Jutta Bergler-Klein
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Christian Hengstenberg
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Andreas Kammerlander
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Stefan Kastl
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (C.L.); (D.B.)
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (C.L.); (D.B.)
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13
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Heyniger JL, Gil KE, Klamer BG, Hor KN, Lee S, Ledingham L, Tong MS, Daniels CJ, Simonetti OP, Rajpal S. Myocardial Inflammation and Fibrosis Are Associated With Reduced Strain in Collegiate Athletes Recovering From SARS-CoV-2. JACC Cardiovasc Imaging 2023; 16:1485-1487. [PMID: 37227333 PMCID: PMC10208378 DOI: 10.1016/j.jcmg.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/26/2023]
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14
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Sánchez Tijmes F, Marschner CA, de Matos JFRG, Urzua Fresno CM, Gutiérrez Chacoff JM, Thavendiranathan P, Fuss C, Hanneman K. Imaging Acute and Chronic Cardiac Complications of COVID-19 and after COVID-19 Vaccination. Radiographics 2023; 43:e230044. [PMID: 37616171 DOI: 10.1148/rg.230044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
COVID-19 is associated with acute and longer-term cardiovascular manifestations including myocardial injury, myopericarditis, stress-induced cardiomyopathy, myocardial infarction, and thromboembolic disease. Although the morbidity and mortality related to acute COVID-19 have decreased substantially, there is growing concern about the longer-term cardiovascular effects of the disease and postacute sequelae. Myocarditis has also been reported after messenger ribonucleic acid (mRNA)-based COVID-19 vaccination, with the highest risk among adolescent boys and young adult men. Noninvasive imaging including cardiac MRI has a key role in identifying the presence of cardiovascular disease, evaluating for potential mechanisms of injury, stratifying risk of future adverse cardiovascular events, and potentially guiding treatment in patients with suspected cardiovascular injury after COVID-19 and vaccination. Patterns of injury identified at cardiac MRI after COVID-19 include myocarditis and pericarditis, myocardial ischemia, and infarction. Myocardial edema and late gadolinium enhancement have been described months after the initial infection in a minority of patients with persistent cardiac symptoms after COVID-19. In patients with myocarditis after receiving a COVID-19 vaccination, the most common pattern of late gadolinium enhancement is subepicardial at the basal inferolateral wall, and patients tend to have milder imaging abnormalities compared with those from other causes of myocarditis. This article describes the role of multimodality cardiac imaging and imaging findings in patients with acute and longer-term cardiovascular manifestations of COVID-19 and in patients with myocarditis after receiving an mRNA-based COVID-19 vaccination. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Felipe Sánchez Tijmes
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Constantin A Marschner
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Joao Francisco Ribeiro Gavina de Matos
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Camila M Urzua Fresno
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Jose Miguel Gutiérrez Chacoff
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Cristina Fuss
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Kate Hanneman
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
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15
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Stefani L, Brown P, Gerges M, Emerson P, Ferkh A, Kairaitis K, Gilroy N, Altman M, Thomas L. Echocardiographic Assessment in Patients Recovered from Acute COVID-19 Illness. J Cardiovasc Dev Dis 2023; 10:349. [PMID: 37623362 PMCID: PMC10456092 DOI: 10.3390/jcdd10080349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
Coronavirus (COVID-19) infections have spread rapidly worldwide and posed an immense public health problem. COVID-19 infection can affect the cardiovascular system both acutely and in patients followed up some period after COVID-19 infection. The aim of this study was to evaluate left ventricular (LV) and right ventricular (RV) function by echocardiography in COVID-19 recovered patients (hospitalized and non-hospitalized). Forty-two patients who recovered from COVID-19 but had ongoing symptoms were included in this retrospective observational cross-sectional study. Patients were followed-up at a median time of 112 days from confirmed COVID-19 diagnosis and a comprehensive echocardiogram was performed. COVID-19 patients were age- and sex-matched to healthy controls. Traditional TTE parameters and advanced echocardiographic parameters including two-dimensional LV global longitudinal strain (GLS) and RV free wall strain (FWS) were measured. LV volumes and LV ejection fraction were similar in COVID-19 patients and controls; however, LV GLS was significantly worse in the COVID-19 group (p = 0.002). Similarly, RV volumes and traditional RV function parameters were similar, but RV FWS (p = 0.009) and RV global strain (p = 0.015) were reduced. Alterations in LV and RV strain were observed in both hospitalized and non-hospitalized patients. In the subset of COVID-19 patients without any co-morbidities (n = 30), LV GLS remained reduced compared to controls. According to multivariate analysis, COVID-19 infection was the only independent determinant of reduced LV GLS (p = 0.012), while COVID-19 infection, diastolic blood pressure, and RV fractional area change were determinants of RV FWS. In this observational study, prior COVID-19 infection demonstrated LV dysfunction in patients with persistent symptoms. Abnormal LV strain was evident in both hospitalized and non-hospitalized patients, suggesting that these changes are independent of the severity of COVID-19 infection at presentation. The use of LV GLS in COVID-19 patients could have potential clinical utility to support the indication for cardiac magnetic resonance imaging in patients with possible COVID-19 related myocarditis. Future longitudinal studies are needed to evaluate its correlation with adverse cardiovascular events.
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Affiliation(s)
- Luke Stefani
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Paula Brown
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Monica Gerges
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Peter Emerson
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Aaisha Ferkh
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Kristina Kairaitis
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead 2145, Australia
| | - Nicole Gilroy
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Department of Infectious Diseases, Westmead Hospital, Westmead 2145, Australia
| | - Mikhail Altman
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
| | - Liza Thomas
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead 2145, Australia; (L.S.)
- Cardiology Department, Westmead Hospital, Westmead 2145, Australia
- Southwestern Clinical School, University of New South Wales, Kensington 2052, Australia
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16
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Yugar-Toledo JC, Yugar LBT, Sedenho-Prado LG, Schreiber R, Moreno H. Pathophysiological effects of SARS-CoV-2 infection on the cardiovascular system and its clinical manifestations-a mini review. Front Cardiovasc Med 2023; 10:1162837. [PMID: 37260945 PMCID: PMC10229057 DOI: 10.3389/fcvm.2023.1162837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 may have a mild presentation, with few symptoms, or progress to a severe condition, characterized by generalized inflammation, systemic microvascular involvement, coagulopathy, and pulmonary and cardiovascular complications. Men present with more severe symptoms than women, especially men who are older and who present with comorbidities such as hypertension, diabetes mellitus, and a history of atherosclerotic diseases. Owing to its association with endothelial dysfunction, inflammation, thrombosis, and microvascular obstruction, SARS-CoV-2 infection can cause lesions in several organs, including the myocardium and the coronary arterial bed, which can result in clinical manifestations involving the cardiovascular system. In this mini review, we summarize the effects of SARS-CoV-2 infection on the cardiovascular system in both children and adults and characterize the various clinical manifestations associated with this disease.
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Affiliation(s)
| | | | | | - Roberto Schreiber
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Heitor Moreno
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
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