Myocardial Injury Prevalent in Patients With Severe COVID-19

Myocarditis-like injury occurs after severe COVID-19 infection, with late gadolinium enhancement and/or ischemia in 54 percent of patients, according to a study published online in the European Heart Journal.

Tushar Kotecha, MBChB, PhD, from the Royal Free London NHS Foundation Trust, and colleagues used multiparametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in 148 patients with severe COVID-19 infection and troponin elevation who were discharged from six hospitals.

The researchers found that 89 percent of patients had normal left ventricular (LV) function. Fifty-four percent had late gadolinium enhancement and/or ischemia. This included myocarditis-like scars, infarction and/or ischemia, and dual pathology in 26, 22, and 6 percent of patients, respectively. In 88 percent of 40 cases, myocarditis-like injury was limited to no more than three myocardial segments, with no associated LV dysfunction; 30 percent of these cases had active myocarditis. In 19 percent of cases, myocardial infarction was found, and in 26 percent of the 76 undergoing stress perfusion, inducible ischemia was observed. Of the 41 patients with an ischemic injury pattern, 66 percent had no past history of coronary disease. The investigators observed no evidence of diffuse fibrosis or edema in the remote myocardium.

“Myocardial injury during COVID-19 infection severe enough to require acute hospital admission is associated with a CMR abnormality in approximately half of patients,” the authors write. “The trajectory and outcome of those with evidence of ongoing localized inflammation remains unknown but would support ongoing research.”

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