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Cited by 384Viral Infections and Immunology ResearchCOVID-19 Clinical Research StudiesCardiac Imaging and Diagnostics

Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance

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Kotecha, Tushar, Knight, Daniel S, Razvi, Yousuf, Kumar, Kartik, Vimalesvaran, Kavitha, Thornton, George, Patel, Rishi, Chacko, Liza +32 more·2021·European Heart Journal
DOI 10.1093/eurheartj/ehab075PMC PMC7928984
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Abstract

Background: Troponin elevation is common in hospitalized COVID-19 patients, but underlying aetiologies are ill-defined. We used multi-parametric cardiovascular magnetic resonance (CMR) to assess myocardial injury in recovered COVID-19 patients. Methods and results: One hundred and forty-eight patients (64 ± 12 years, 70% male) with severe COVID-19 infection [all requiring hospital admission, 48 (32%) requiring ventilatory support] and troponin elevation discharged from six hospitals underwent convalescent CMR (including adenosine stress perfusion if indicated) at median 68 days. Left ventricular (LV) function was normal in 89% (ejection fraction 67% ± 11%). Late gadolinium enhancement and/or ischaemia was found in 54% (80/148). This comprised myocarditis-like scar in 26% (39/148), infarction and/or ischaemia in 22% (32/148) and dual pathology in 6% (9/148). 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. 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). Of patients with ischaemic injury pattern, 66% (27/41) had no past history of coronary disease. There was no evidence of diffuse fibrosis or oedema in the remote myocardium (T1: COVID-19 patients 1033 ± 41 ms vs. matched controls 1028 ± 35 ms; T2: COVID-19 46 ± 3 ms vs. matched controls 47 ± 3 ms). Conclusions: During convalescence after severe COVID-19 infection with troponin elevation, myocarditis-like injury can be encountered, with limited extent and minimal functional consequence. In a proportion of patients, there is evidence of possible ongoing localized inflammation. A quarter of patients had ischaemic heart disease, of which two-thirds had no previous history. Whether these observed findings represent pre-existing clinically silent disease or de novo COVID-19-related changes remain undetermined. Diffuse oedema or fibrosis was not detected.

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  • Multiple studies reported cardiovascular complications from COVID-19 including myocarditis that ranged from 18% to 60% of cases.

    “However, multiple studies reported cardiovascular complications from COVID-19 including myocarditis that ranged from 18% to 60% of cases.”

    From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [107]

    The Results (Cardiovascular magnetic resonance; page unavailable) report myocarditis-pattern injury in 27% of 148 recovered, hospitalized COVID-19 patients with elevated troponin. The Discussion also mentions a preliminary study suggesting 15% in competitive athletes, but says the true prevalence of myocarditis in COVID-19 is unknown. The paper supports the occurrence of cardiac injury, not the attributed 18%–60% range across multiple studies or its application to COVID-19 cases generally. (LLM, conf=0.85)

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Authors
Kotecha, T., Knight, D. S., Razvi, Y., Kumar, K., Vimalesvaran, K., Thornton, G., Patel, R., Chacko, L., Brown, J. T., Coyle, C., Leith, D., Shetye, A., Ariff, B., Bell, R., Captur, G., Coleman, M., Goldring, J., Gopalan, D., Heightman, M., Hillman, T., Howard, L., Jacobs, M., Jeetley, P. S., Kanagaratnam, P., Kon, O. M., Lamb, L. E., Manisty, C. H., Mathurdas, P., Mayet, J., Negus, R., Patel, N., Pierce, I., Russell, G., Wolff, A., Xue, H., Kellman, P., Moon, J. C., Treibel, T. A., Cole, G. D., & Fontana, M.
Affiliations
  • Royal Free London NHS Foundation Trust (GB)
  • Imperial College Healthcare NHS Trust (GB)
  • Barts Health NHS Trust (GB)
  • University College London Hospitals NHS Foundation Trust (GB)
  • National Institutes of Health (US)
Corresponding author
Fontana, Marianna
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2021-02-18
Volume
42
Issue
19
Pages
1866-1878
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehab075
PMC
PMC7928984
OpenAlex
W3131065350
Cited by
384
References
2
Citations by year
2026: 14 · 2025: 27 · 2024: 52 · 2023: 88 · 2022: 112 · 2021: 89
FWCI
57.32
Type
journal article
Language
en
Open access
Licence
Locations
  • European Heart Journal (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • National Institute for Health Research
  • University College London Hospitals
  • Biomedical Research Centre
  • Barts NIHR Biomedical Research Centres
  • BHF Accelerator Award (AA/18/6/34223)
  • British Heart Foundation
  • Intermediate Fellowships (FS/18/21/33447, FS/19/35/34374)
  • NIHR Imperial Biomedical Research Centre
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
COVID-19 pandemic, myocardial injury, troponin elevation, myocarditis, myocardial infarction, myocardial ischemia, late gadolinium enhancement, myocardial perfusion, adenosine stress perfusion, left ventricular function, post-COVID-19 recovery, myocardial fibrosis, myocardial edema
MeSH terms
COVID-19, SARS-CoV-2, Contrast Media, Female, Gadolinium, Humans, Male, Myocarditis, Myocardium, Magnetic Resonance Spectroscopy, Predictive Value of Tests, Troponin, Ventricular Function, Left, Magnetic Resonance Imaging, Cine

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