Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement

Mahesh K. Vidula; Justyna Rajewska-Tabor; J. Jane Cao; Yu Kang; Jason Craft; Winifred Mei; Preethi S. Chandrasekaran; Daniel E. Clark; Ana Maria Poenar; Miroslawa Gorecka; Maan Malahfji; Eilidh Cowan; Jennifer M. Kwan; Samuel W. Reinhardt; Sarah Al-Tabatabaee; Patrick Doeblin; Adriana D.M. Villa; Ilya Karagodin; Nazia Alvi; Panagiota Christia; Nicholas Spetko; Mark Philip Cassar; Christine Park; Lakshmi Nambiar; Alper Turgut; Mahan Roosta Azad; Moritz Lambers; Timothy C. Wong; Michael Salerno; Jiwon Kim; Michael Elliott; Betty Raman; Stefan Neubauer; Connie W. Tsao; Gina LaRocca; Amit R. Patel; Amedeo Chiribiri; Sebastian Kelle; Lauren A. Baldassarre; Dipan J. Shah; Sean G. Hughes; Matthew S. Tong; Malgorzata Pyda; Orlando P. Simonetti; Sven Plein; Yuchi Han

doi:10.1016/j.jcmg.2022.10.021

Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement

Mahesh K. Vidula, Justyna Rajewska-Tabor, J. Jane Cao, Yu Kang, Jason Craft, Winifred Mei, Preethi S. Chandrasekaran, Daniel E. Clark, Ana Maria Poenar, Miroslawa Gorecka, Maan Malahfji, Eilidh Cowan, Jennifer M. Kwan, Samuel W. Reinhardt, Sarah Al-Tabatabaee, Patrick Doeblin, Adriana D.M. Villa, Ilya Karagodin, Nazia Alvi, Panagiota ChristiaNicholas Spetko, Mark Philip Cassar, Christine Park, Lakshmi Nambiar, Alper Turgut, Mahan Roosta Azad, Moritz Lambers, Timothy C. Wong, Michael Salerno, Jiwon Kim, Michael Elliott, Betty Raman, Stefan Neubauer, Connie W. Tsao, Gina LaRocca, Amit R. Patel, Amedeo Chiribiri, Sebastian Kelle, Lauren A. Baldassarre, Dipan J. Shah, Sean G. Hughes, Matthew S. Tong, Malgorzata Pyda, Orlando P. Simonetti, Sven Plein, Yuchi Han

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

BACKGROUND: Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood.

OBJECTIVES: The 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).

METHODS: This 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.

RESULTS: In 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).

CONCLUSIONS: In 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.

Original language	English (US)
Pages (from-to)	609-624
Number of pages	16
Journal	JACC: Cardiovascular Imaging
Volume	16
Issue number	5
DOIs	https://doi.org/10.1016/j.jcmg.2022.10.021
State	Published - May 2023

Keywords

cardiac magnetic resonance (CMR)
COVID-2019
myocardial injury
Predictive Value of Tests
Myocarditis/pathology
COVID-19/complications
Magnetic Resonance Spectroscopy
Humans
Coronary Artery Disease
Magnetic Resonance Imaging
Troponin
Heart Injuries
Retrospective Studies

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Radiology Nuclear Medicine and imaging

Access to Document

10.1016/j.jcmg.2022.10.021

Cite this

Vidula, M. K., Rajewska-Tabor, J., Cao, J. J., Kang, Y., Craft, J., Mei, W., Chandrasekaran, P. S., Clark, D. E., Poenar, A. M., Gorecka, M., Malahfji, M., Cowan, E., Kwan, J. M., Reinhardt, S. W., Al-Tabatabaee, S., Doeblin, P., Villa, A. D. M., Karagodin, I., Alvi, N., ... Han, Y. (2023). Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement. JACC: Cardiovascular Imaging, 16(5), 609-624. https://doi.org/10.1016/j.jcmg.2022.10.021

Vidula, MK, Rajewska-Tabor, J, Cao, JJ, Kang, Y, Craft, J, Mei, W, Chandrasekaran, PS, Clark, DE, Poenar, AM, Gorecka, M, Malahfji, M, Cowan, E, Kwan, JM, Reinhardt, SW, Al-Tabatabaee, S, Doeblin, P, Villa, ADM, Karagodin, I, Alvi, N, Christia, P, Spetko, N, Cassar, MP, Park, C, Nambiar, L, Turgut, A, Azad, MR, Lambers, M, Wong, TC, Salerno, M, Kim, J, Elliott, M, Raman, B, Neubauer, S, Tsao, CW, LaRocca, G, Patel, AR, Chiribiri, A, Kelle, S, Baldassarre, LA, Shah, DJ, Hughes, SG, Tong, MS, Pyda, M, Simonetti, OP, Plein, S & Han, Y 2023, 'Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement', JACC: Cardiovascular Imaging, vol. 16, no. 5, pp. 609-624. https://doi.org/10.1016/j.jcmg.2022.10.021

@article{52702773e581473796c15c6a76449544,

title = "Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement",

abstract = "BACKGROUND: Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood.OBJECTIVES: The 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).METHODS: This 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.RESULTS: In 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).CONCLUSIONS: In 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.",

keywords = "cardiac magnetic resonance (CMR), COVID-2019, myocardial injury, Predictive Value of Tests, Myocarditis/pathology, COVID-19/complications, Magnetic Resonance Spectroscopy, Humans, Coronary Artery Disease, Magnetic Resonance Imaging, Troponin, Heart Injuries, Retrospective Studies",

author = "Vidula, {Mahesh K.} and Justyna Rajewska-Tabor and Cao, {J. Jane} and Yu Kang and Jason Craft and Winifred Mei and Chandrasekaran, {Preethi S.} and Clark, {Daniel E.} and Poenar, {Ana Maria} and Miroslawa Gorecka and Maan Malahfji and Eilidh Cowan and Kwan, {Jennifer M.} and Reinhardt, {Samuel W.} and Sarah Al-Tabatabaee and Patrick Doeblin and Villa, {Adriana D.M.} and Ilya Karagodin and Nazia Alvi and Panagiota Christia and Nicholas Spetko and Cassar, {Mark Philip} and Christine Park and Lakshmi Nambiar and Alper Turgut and Azad, {Mahan Roosta} and Moritz Lambers and Wong, {Timothy C.} and Michael Salerno and Jiwon Kim and Michael Elliott and Betty Raman and Stefan Neubauer and Tsao, {Connie W.} and Gina LaRocca and Patel, {Amit R.} and Amedeo Chiribiri and Sebastian Kelle and Baldassarre, {Lauren A.} and Shah, {Dipan J.} and Hughes, {Sean G.} and Tong, {Matthew S.} and Malgorzata Pyda and Simonetti, {Orlando P.} and Sven Plein and Yuchi Han",

year = "2023",

month = may,

doi = "10.1016/j.jcmg.2022.10.021",

language = "English (US)",

volume = "16",

pages = "609--624",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier",

number = "5",

}

TY - JOUR

T1 - Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement

AU - Vidula, Mahesh K.

AU - Rajewska-Tabor, Justyna

AU - Cao, J. Jane

AU - Kang, Yu

AU - Craft, Jason

AU - Mei, Winifred

AU - Chandrasekaran, Preethi S.

AU - Clark, Daniel E.

AU - Poenar, Ana Maria

AU - Gorecka, Miroslawa

AU - Malahfji, Maan

AU - Cowan, Eilidh

AU - Kwan, Jennifer M.

AU - Reinhardt, Samuel W.

AU - Al-Tabatabaee, Sarah

AU - Doeblin, Patrick

AU - Villa, Adriana D.M.

AU - Karagodin, Ilya

AU - Alvi, Nazia

AU - Christia, Panagiota

AU - Spetko, Nicholas

AU - Cassar, Mark Philip

AU - Park, Christine

AU - Nambiar, Lakshmi

AU - Turgut, Alper

AU - Azad, Mahan Roosta

AU - Lambers, Moritz

AU - Wong, Timothy C.

AU - Salerno, Michael

AU - Kim, Jiwon

AU - Elliott, Michael

AU - Raman, Betty

AU - Neubauer, Stefan

AU - Tsao, Connie W.

AU - LaRocca, Gina

AU - Patel, Amit R.

AU - Chiribiri, Amedeo

AU - Kelle, Sebastian

AU - Baldassarre, Lauren A.

AU - Shah, Dipan J.

AU - Hughes, Sean G.

AU - Tong, Matthew S.

AU - Pyda, Malgorzata

AU - Simonetti, Orlando P.

AU - Plein, Sven

AU - Han, Yuchi

PY - 2023/5

Y1 - 2023/5

N2 - BACKGROUND: Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood.OBJECTIVES: The 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).METHODS: This 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.RESULTS: In 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).CONCLUSIONS: In 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.

AB - BACKGROUND: Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood.OBJECTIVES: The 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).METHODS: This 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.RESULTS: In 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).CONCLUSIONS: In 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.

KW - cardiac magnetic resonance (CMR)

KW - COVID-2019

KW - myocardial injury

KW - Predictive Value of Tests

KW - Myocarditis/pathology

KW - COVID-19/complications

KW - Magnetic Resonance Spectroscopy

KW - Humans

KW - Coronary Artery Disease

KW - Magnetic Resonance Imaging

KW - Troponin

KW - Heart Injuries

KW - Retrospective Studies

UR - http://www.scopus.com/inward/record.url?scp=85152746709&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85152746709&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2022.10.021

DO - 10.1016/j.jcmg.2022.10.021

M3 - Article

C2 - 36752429

AN - SCOPUS:85152746709

SN - 1936-878X

VL - 16

SP - 609

EP - 624

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 5

ER -

Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this