A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: A multicenter cardiovascular magnetic resonance study

BACKGROUND

Coronavirus disease-19 (COVID-19) is a great medical challenge provoking acute respiratory distress, pulmonary manifestations, and cardiovascular (CV) consequences.

AIMS

This study compares cardiac injury in COVID-19 myocarditis patients with non-COVID myocarditis patients.

METHODS

Patients who recovered from COVID-19 were scheduled for cardiovascular magnetic resonance (CMR) owing to clinical myocarditis suspicion. The retrospective non-COVID-19 myocarditis (2018-2019) group was enrolled (n=221 patients). All patients underwent a contrast-enhanced CMR, conventional myocarditis protocol, and late gadolinium enhancement (LGE). The COVID study group included 552 patients with a mean (standard deviation [SD]) age 45.9 (12.6) years old.

RESULTS

CMR assessment confirmed a myocarditis-like LGE in 46% of the cases (68.5% of the segments with LGE <25% transmural extent), left ventricular (LV) dilatation in 10%, and systolic dysfunction in 16%. The COVID-myocarditis group showed a smaller median (interquartile range [IQR]) LV LGE (4.4% [2.9%-8.1%] vs. 5.9% [4.4%-11.8%]; P <0.001), lower LVEDV (144.6 [125.5-178] ml vs. 162.8 [136.6-194] ml; P <0.001), limited functional consequence (LVEF, 59% [54.1%-65%] vs. 58% [52%-63%]; P = 0.01), and a higher rate of pericarditis (13.6% vs. 6%; P = 0.03) compared to non-COVID myocarditis. The COVID-induced injury was more frequent in septal segments (2, 3, 14), and non-COVID myocarditis showed higher affinity to lateral wall segments (P <0.01). Neither obesity nor age was associated with LV injury or remodeling in subjects with COVID-myocarditis.

CONCLUSIONS

COVID-19-induced myocarditis is associated with minor LV injury with a significantly more frequent septal pattern and a higher pericarditis rate than non-COVID-19 myocarditis.

Temporal changes of the diameter of the coronary sinus during the cardiac cycle

INTRODUCTION

Currently, there are no studies that analyse the changes in the cardiac venous system that are dependent on the phase (RR interval) of reconstruction. The aim of the study was to assess the size of the coronary sinus at two measurement sites depending on the phase of the heart cycle.

METHODS

Fifty patients were included. Cardiac computed tomography was performed in all of the patients due to a suspicion of coronary artery disease (typical indications) using a dual-source Siemens Somatom Force scanner. The "MM reading" presets were used to measure the coronary sinus ostium (measurement 1) and the coronary sinus trunk, which is close to the great cardiac vein (measurement 2) in millimetres. All of the calculations were performed on axial scans using 0%-100% and a 256 × 256 matrix.

RESULTS

The largest CS was found at the 30%, 40% and 50% RR interval-this phenomenon occurred in 37 of the 50 cases (74%). The CS was largest in the 30% phase (9/50 cases; 18%), in the 40% phase (17/50 cases; 34%) and in the 50% phase, and it was the largest in 11 of the 50 cases (22%). There were also no gender-related differences.

CONCLUSIONS

The size of the coronary sinus varies with the phase of the heart cycle. At the 40% phase, it is largest in most cases.