16 Advances in multi-parametric CMR now include quantitative ischaemia assessment, and detailed tissue characterization including scar, diffuse fibrosis, and oedema. 14Ĭardiovascular magnetic resonance (CMR) is useful to provide a diagnosis in patients with elevated troponin from unclear aetiology 14, 15 and is recommended by position statements. 13 Furthermore, concern is growing on the long-term sequalae in COVID-19 survivors, which represent an increasing number of patients as the pandemic progresses.
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12 A variety of mechanisms responsible for troponin rise have been proposed including acute coronary syndromes, unmasking occult underlying cardiovascular disease, arrhythmias, myocarditis, or as part of a systemic inflammatory syndrome. 8, 10, 11 Patients with severe COVID-19 disease frequently have high rates of comorbidity associated with cardiac disease including diabetes, airways disease, and obesity. 4, 5 Similarly, elevated troponin is common in hospitalized COVID-19 patients 6–11 and is associated with adverse outcomes. Involvement of multiple organs including the heart has been reported 2, 3 and concern is growing that survivors may endure long-term sequelae, particularly after intensive care admission.Īcute respiratory infections and sepsis are often associated with elevated serum troponin levels, which are associated with mortality even after recovery. 1 Although most cases are mild, a minority of patients sustain severe acute respiratory syndrome, the most frequent cause of death.
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See page 1879 for the editorial comment on this article (doi: 10.1093/eurheartj/ehab145) IntroductionĬOVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global pandemic that continues to cause significant mortality and morbidity worldwide. matched controls 47 ± 3 ms).ĬOVID-19, SARS-CoV-2, Cardiovascular magnetic resonance, Myocarditis, Myocardial infarction, Myocardial oedema There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. Myocardial infarction was found in 19% (28/148) and inducible ischaemia in 26% (20/76) of those undergoing stress perfusion (including 7 with both infarction and ischaemia).
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Myocarditis-like injury was limited to three or less myocardial segments in 88% (35/40) of cases with no associated LV dysfunction of these, 30% had active myocarditis. This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days.