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

Maciej Haberka12, Justyna Rajewska-Tabor3, Dagmara Wojtowicz4, Anna Jankowska5, Karol Miszalski-Jamka6, Magdalena Janus3, Karolina Dorniak7, Dorota Kulawiak-Gałąska8, Bartłomiej Stasiow2, Szymon Rozmiarek3, Edyta Szurowska9, Waldemar Elikowski10, Marzena Ławrynowicz4, Mateusz Śpiewak11, Marek Koziński4, Małgorzata Pyda3
DOI: 10.33963/KP.a2023.0054
·
Pubmed: 36871296
Affiliations
  1. Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland
  2. Department of Cardiovascular Imaging, CMR unit, Upper Silesian Medical Centre of the Medical University of Silesia, Katowice, Poland
  3. 1st Department of Cardiology, CMR unit, Poznan University of Medical Sciences, Poznań, Poland
  4. Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdynia, Poland
  5. Department of Cardiology, Cardinal Wyszynski Specialist Hospital, Lublin, Poland
  6. Diagnostic Imaging Department, Silesian Center for Heart Diseases, Zabrze, Poland
  7. Department of Noninvasive Cardiac Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
  8. Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
  9. 2nd Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
  10. Infectious diseases hospital for COVID-19, Józef Strus Municipal Hospital, Poznań, Poland
  11. Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, Warszawa, Poland

open access

Online first
Original article
Published online: 2023-03-05

Abstract

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.

Abstract

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.

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Keywords

COVID-19, myocarditis, CMR, LGE, myocardial injury

About this article
Title

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

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2023-03-05

Page views

21

Article views/downloads

32

DOI

10.33963/KP.a2023.0054

Pubmed

36871296

Keywords

COVID-19
myocarditis
CMR
LGE
myocardial injury

Authors

Maciej Haberka
Justyna Rajewska-Tabor
Dagmara Wojtowicz
Anna Jankowska
Karol Miszalski-Jamka
Magdalena Janus
Karolina Dorniak
Dorota Kulawiak-Gałąska
Bartłomiej Stasiow
Szymon Rozmiarek
Edyta Szurowska
Waldemar Elikowski
Marzena Ławrynowicz
Mateusz Śpiewak
Marek Koziński
Małgorzata Pyda

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