| Institution: | 1. Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;2. Department of Magnetic Resonance, I Clinic of Cardiology, University of Medical Sciences, Poznan, Poland;3. St. Francis Hospital, Roslyn, New York, USA;4. Division of Cardiology, The Ohio State University, Columbus, Ohio, USA;5. Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA;6. Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom;7. Houston Methodist Heart and Vascular Center, Houston, Texas, USA;8. Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA;9. Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany;10. School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom;11. Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA;12. Icahn School of Medicine at Mount Sinai, New York, New York, USA;13. Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;14. Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom;15. Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA;p. Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA;q. Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany;r. Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;s. Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA |
| Abstract: | BackgroundMyocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood.ObjectivesThe purpose of this study was to characterize myocardial injury in a multicenter cohort of patients with COVID-19 and suspected cardiac involvement referred for cardiac magnetic resonance (CMR).MethodsThis retrospective study consisted of 1,047 patients from 18 international sites with polymerase chain reaction–confirmed COVID-19 infection who underwent CMR. Myocardial injury was characterized as acute myocarditis, nonacute/nonischemic, acute ischemic, and nonacute/ischemic patterns on CMR.ResultsIn this cohort, 20.9% of patients had nonischemic injury patterns (acute myocarditis: 7.9%; nonacute/nonischemic: 13.0%), and 6.7% of patients had ischemic injury patterns (acute ischemic: 1.9%; nonacute/ischemic: 4.8%). In a univariate analysis, variables associated with acute myocarditis patterns included chest discomfort (OR: 2.00; 95% CI: 1.17-3.40, P = 0.01), abnormal electrocardiogram (ECG) (OR: 1.90; 95% CI: 1.12-3.23; P = 0.02), natriuretic peptide elevation (OR: 2.99; 95% CI: 1.60-5.58; P = 0.0006), and troponin elevation (OR: 4.21; 95% CI: 2.41-7.36; P < 0.0001). Variables associated with acute ischemic patterns included chest discomfort (OR: 3.14; 95% CI: 1.04-9.49; P = 0.04), abnormal ECG (OR: 4.06; 95% CI: 1.10-14.92; P = 0.04), known coronary disease (OR: 33.30; 95% CI: 4.04-274.53; P = 0.001), hospitalization (OR: 4.98; 95% CI: 1.55-16.05; P = 0.007), natriuretic peptide elevation (OR: 4.19; 95% CI: 1.30-13.51; P = 0.02), and troponin elevation (OR: 25.27; 95% CI: 5.55-115.03; P < 0.0001). In a multivariate analysis, troponin elevation was strongly associated with acute myocarditis patterns (OR: 4.98; 95% CI: 1.76-14.05; P = 0.003).ConclusionsIn this multicenter study of patients with COVID-19 with clinical suspicion for cardiac involvement referred for CMR, nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present. |
