Several studies have described direct SARS-CoV-2 myocardial infection, raising the possibility of direct cardiotropic nature of COVID-19 in some patients. |
Abnormal CMR findings have been reported in up to 33% of pediatric MIS-C patients. |
Up to 14% of pediatric patients continue to have abnormal CMR at follow-up. |
The clinical implications of these residual abnormal features is yet unknown, highlighting the importance of continued long-term follow-up. |
Background
SARS-COV-2 and the Myocardium
Non-Invasive Imaging Findings with COVID-19
Myocarditis
Imaging Findings in Adults with COVID-19
Imaging Findings in Collegiate Athletes with COVID-19
Study authors | No. of patients | Age (years) | COVID-19 cardiac diagnosis | Echo findings | CMR, normal/abnormal? | CMR findings |
---|---|---|---|---|---|---|
Puntmann et al. | 100 | 49 ± 14 | Recovered COVID-19 (1/3 hospitalized during Dx) | - | 78% abnormal CMR | 73% had increased native T1, 60% had increased native T2 32% had LGE, 22% had PCE |
Chen et al. | 25 | (range 18—35) | Symptomatic COVID-19 | - | CMR performed within 10 days of symptom onset | Increased mean native T1 mapping vs. controls Increased mean T2 mapping vs. controls Increased mean ECV vs. controls Worsened mean LV GLS vs. controls |
Daniels et al. | 1597 | (collegiate athletes) | Myocarditis in 9 Subclinical myocarditis in 28 | Abnormal in 5/37 (2 myocarditis, 3 subclinical myocarditis) | 37/1597 diagnosed with myocarditis (2.3%) | 31 had CMR findings of myocarditis 31/37 (84%) having increased T2, 5/37 (14%) had increased T1 LGE was seen in 36/37 (97%) 27/38 had follow-up CMR; resolution of T2 elevation in 100%, LGE resolution in 41% |
Malek et al. | 26 elite athletes | 24 (IQ 21—27) | Asymptomatic/mild COVID-19 | - | 5/26 (19%) abnormal CMR CMR performed 32 days from diagnosis | No cases of myocarditis (LLC) 4/26 (15%) had edema by T1/T2/ECV 1/26 (4%) had LGE 1/26 (4%) had PCE |
Martinez et al. | 789 professional athletes | 25 ± 3 | Recovered symptomatic or mild/asymptomatic COVID-19 | 2.5% had abnormal echocardiography (mild LV dysfunction, PCE) | 27 CMR performed | 3/27 (11%) had myocarditis 2/ 27 (%) had PCE |
Kotecha et al. | 148 | 64 ± 12 | Recovered severe COVID-19 | Decreased LVEF in 11% | CMR performed 68 days from confirmed COVID Dx | 13% had increased T1 3% had increased T2 35% had LGE |
Huang et al. | 26 | 38 (IQ 32—45) | Recovered (prev hospitalized) COVID-19 | - | 58% had abnormal CMR | 28% had increased T1 25% had increased T2 24% had increased ECV 31% had LGE |
Joy et al. | 149 | 37 (range 18—63) | Mild COVID in healthcare workers | - | CMR performed 6 months post COVID-19 DX | 6/149 4%) had increased T1 9/149 (6%) had increased T2 13/149 (9%) had LGE |
Valverde et al. | 286 | 8.4 (IQ 3.8—12.4) | MIS-C | Decreased LVEF in 34% PCE mod + in 3.1% Reduced LV GLS in 26.5% CA abnormal in 24.1% | 42/286 had CMR performed 33% abnormal | Increased T2 signal in 33% LGE in 14.3% |
Feldstein et al. | 1116 | 9.7 (IQ 4.7—13.2) | MIS-C | Decreased LVEF in 34% CA abnormal 13.4% | - | - |
Belhadjer et al. | 35 | 10 (IQ 2—16) | MIS-C | LVEF < 30% in 28% LVEF 30—50% in 72% | - | - |
Bermejo et al. | 20 | 8 (range 17 months to 14 years) | MIS-C | LVEF decreased in 50% CA abnormal in 25% | CMR performed 27 ± 14 days from SSX onset | 1/20 (5%) had increased T1 1/20 (5%) had increased T2 2/20 (10%) had LGE |
MIS-C
Age in years (median; range) | 8 (0.3–19) |
---|---|
Male | 52.3% (n = 46) |
Female | 47.7% (n = 42) |
Race | |
White | 42% (n = 37) |
African American | 46.6% (n = 41) |
Latino/Hispanic | 4.6% (n = 4) |
Multiracial | 6.8% (n = 6) |
Systems involved by symptoms at admission | |
Fever | 100% (n = 88) |
Duration of fever in days | 4.5 (SD = 3.3) |
Gastrointestinal | 85.2% (n = 75) |
Mucocutaneus | 46.6% (n = 41) |
Cardiovascular | 46.6% (n = 41) |
Respiratory | 39.8% (n = 35) |
Musculoskeletal | 13.6% (n = 12) |
Neurologic | 44.3% (n = 39) |
Clinical outcomes | |
Length of stay in days | 8.4 (SD = 4.9) |
Admission to PICU | 44.3% (n = 39) |
Use of vasoactives | 34.1% (n = 30) |
Cardiac dysfunction | 40.7% (n = 35) |
Coronary involvement | 27.6% (n = 24) |
Therapies used | |
IVIG | 94.3% (n = 83) |
Steroids | 89.8% (n = 79) |
Anakinra | 10.2% (n = 9) |
Remdesivir | 1.1% (n = 1) |
Aspirin | 92% (n = 81) |
Anticoagulation | |
Prophylactic | 73.9% (n = 65) |
Therapeutic | 23.9% (n = 21) |