Study Acute, Post-Acute COVID-19 Patients with Suspected Myocarditis

Medical Research -- January 8, 2023: The Study -- Pre-existing cardiovascular illness, disease severity,
and poor outcomes are associated with COVID-19-related cardiac damage.

The goal is to present cardiac magnetic resonance (CMR) findings in individuals with myocarditis-like syndrome during SARS-CoV-2 infection (AMCovS) and post-acute phase (cPACS).

Data were obtained from individuals with clinically suspected myocarditis in the acute and post-acute COVID-19 phases who underwent 1.5 Tesla CMR imaging between September 2020 and January 2022. These individuals had SARS-CoV-2 infections that were confirmed by RT-PCR (reverse transcription-polymerase chain reaction). Data were gathered from the electronic health records of each and every patient. This data included anthropometric factors, laboratory analytical data, cardiac comorbid problems, and information on the patients' status during SARS-CoV-2 infection for AMCovS and cPACS patients.

The findings of the CMR were examined in a consistent manner by two separate observers. It was clinically suspected that the patient had cardiovascular damage due to the following: I symptoms including chest pain, breathlessness, palpitation, arrhythmias, and dyspnea; (ii) an increase in hs-cTnT (high-sensitivity cardiac troponin T) level that did not meet the criteria for a diagnosis of myocardial infarction; and (iii) abnormal electrocardiography (ECG) and/or echocardiography findings that did not

Cine-SSFP (cine steady-state free precession) images were examined for the purpose of determining changes in wall motion as well as the function and volume of the heart chambers. STIR (short-tau inversion-recovery) and T2 images were evaluated in order to determine the severity of the edema. LGE (late gadolinium enhancement) images were analyzed in order to locate the cardiac scar. In order to determine the extracellular volume fraction, both the native T1 pictures and the post-contrast T1 images were studied. It was stated what kind of cardiovascular changes there were and how extensive they were in the CMR images.

Results
39 patients were included in the study, 17 of them were diagnosed with AMCovS and 22 with cPACS. Of these patients, 62% (n = 24) were male. AMCovS patients were predominately male (59%, n=10), the median patient age was 57.0 years, and they had elevated hs-cTnT levels (median peak at 122 ng/L) related to acute pain in the chest (71%, n=12) with ST-T segment alterations (53%, n=9). Patients with AMCovS had a median patient age of 57.0 years. The majority of patients, 76%, had at least one comorbid condition. 35% of patients diagnosed with AMCovS were admitted to an intensive care unit (ICU) because they were experiencing cardiogenic shock in conjunction with acute respiratory distress syndrome (ARDS) or moderate pneumonia.

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Patients diagnosed with AMCovS had normal left ventricular (LV) systolic functioning in 88% of cases (n=15), with an LV-ejection fraction (EF) of 65%, and normal median LV volume index values. The right ventricular (RV) systolic functioning was normal in 94% (n=16) of the cases, with normal values for the RV volume indices, with the exception of one ICU-admitted patient who had mild RV dilation (RV-end diastolic volume index (EDVi) value of 97.0 ml per square meter) and moderate RV systolic derangement (RV-EF of 40%), along with LGE and diffuse Necrotizing myocarditis was identified as the patient's condition after a histopathological study was performed.

Over fifty-two percent of individuals (n=9) were found to have myocarditis diagnosis criteria, and focal-type edema was found in seventy-eight percent of patients (n=7). This edema primarily involved the inferior part of the middle-basal wall and septum, which accounted for sixty-seven percent of patients (n=5). Elevated values of 55 ms were seen in the T2 scans of all of the patients. In addition, all of the patients (with the exception of one patient) demonstrated non-ischemic LGE involving the inferior wall and the septum (63%, n=5), with a modest scar load affecting 1.0% of myocardial mass. This was observed in all of the individuals. In 24% (n=4) of patients, focal-type edema with ischemic LGE was detected in four cardiac segments, indicative of acute myocardial infarctions.

In the cPACS group, there were 22 patients who had CMR imaging because they were experiencing persistent cardiac symptoms such as dyspnea (45%, n=10) and recurring pain in the chest (55%, n=12). 64% of these patients were male, and the median patient age was 38 years. Ten people had a previous history of COVID-19-associated hospitalization, and seven of those people had raised hs-cTnT levels (with a median peak of 238 ng/L). None of the ten people had any history of obstructive-type coronary artery disease (CAD) (coronary artery disease). In excess of 58% of individuals, ventricular arrhythmia was present. Other abnormalities included wall motion alterations and ventricular dysfunction.

CMR examinations of patients diagnosed with cPACS revealed active-type myocarditis in 36% (n=8) of patients, healed myocarditis in 14% (n=3) of patients, and pericarditis in 9.0% (n=2) of patients, respectively. Over twenty-six percent of patients, or six total, were found to have diverse forms of cardiomyopathy. These forms included dilated cardiomyopathy (DCM) in three patients, prolapse of the mitral valve with arrhythmogenic characteristics in two patients, and myocardial non-compaction in one patient. The findings from the CMR on three patients were normal.

Six people diagnosed with active-type myocarditis had localized edema affecting two segments of their heart that had larger T2 values than 55 milliseconds. Patterns of non-ischemic LGE were seen in the mid-basal wall on the lateral aspect in 63% of the cases (n=5), which involved two myocardial segments with a scar burden of 2.0%. The three patients who had recovered from myocarditis had no signs of edema, LGE in all four segments of the inferior and lateral walls, and T2 values that fell within the normal range.

The findings of the study showed that CMR imaging enabled the non-invasive characterization of ischemic and non-ischemic cardiac damage and unraveled cardiomyopathies among individuals experiencing myocarditis-like symptoms during the acute and post-acute phases of COVID-19. This was the case among participants who had previously been diagnosed with COVID-19. Therefore, the method ought to be included in the diagnostic workup of COVID-19 patients so as to make it possible for individualized and advanced patient care and to lessen the burden of SARS-CoV-2 infections on the health system.

Palmisiano, Anna, et al. “Cardiac Magnetic Resonance Findings in Acute and Post-acute COVID-19 Patients With Suspected Myocarditis.” Cardiac Magnetic Resonance Findings in Acute and Post-acute COVID-19 Patients With Suspected Myocarditis, 21 Dec. 2022, doi.org/10.1002/jcu.23416.