心脏 T1 和 T2 映射显示，最初认为没有心脏损伤的 COVID-19 康复患者存在心肌受累。
Cardiac T1 and T2 Mapping Showed Myocardial Involvement in Recovered COVID-19 Patients Initially Considered Devoid of Cardiac Damage.
机构信息
Radiology Department, The Fifth Affiliated Hospital of Sun-Yat Sen University, Zhuhai, China.
Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital of Sun-Yat Sen University, Zhuhai, China.
出版信息
J Magn Reson Imaging. 2021 Aug;54(2):421-428. doi: 10.1002/jmri.27534. Epub 2021 Feb 16.
BACKGROUND
Myocardial injury has been found using magnetic resonance imaging in recovered coronavirus disease 2019 (COVID-19) patients unselected or with ongoing cardiac symptoms.
PURPOSE
To evaluate for the presence of myocardial involvement in recovered COVID-19 patients without cardiovascular symptoms and abnormal serologic markers during hospitalization.
STUDY TYPE
Prospective.
POPULATION
Twenty-one recovered COVID-19 patients and 20 healthy controls (HC).
FIELD STRENGTH/SEQUENCE: 3.0 T, cine, T2-weighted imaging, T1 mapping, and T2 mapping.
ASSESSMENT
Cardiac ventricular function includes end-diastolic volume, end-systolic volume, stroke volume, cardiac output, left ventricle (LV) mass, and ejection fraction (EF) of LV and right ventricle (RV), and segmental myocardial T1 and T2 values were measured.
STATISTICAL TESTS
Student's t-test, univariate general linear model test, and chi-square test were used for analyses between two groups. Ordinary one-way analyses of variance or Kruskal-Wallis H test were used for analyses between three groups, followed by post-hoc analyses.
RESULTS
Fifteen (71.43%) COVID-19 patients had abnormal magnetic resonance findings, including raised myocardial native T1 (5, 23.81%) and T2 values (10, 47.62%), decreased LVEF (1, 4.76%), and RVEF (2, 9.52%). The segmental myocardial T2 value of COVID-19 patients (49.20 [46.1, 54.6] msec) was significantly higher than HC (48.3 [45.2, 51.7] msec) (P < 0.001), while the myocardial native T1 value showed no significant difference between COVID-19 patients and HC. The myocardial T2 value of serious COVID-19 patients (52.5 [48.1, 57.1] msec) was significantly higher than unserious COVID-19 patients (48.8 [45.9, 53.8] msec) and HC (48.3 [45.2, 51.7]) (P < 0.001). COVID-19 patients with abnormally elevated D-dimer, C-reactive protein, or lymphopenia showed higher myocardial T2 values than without (all P < 0.05).
DATA CONCLUSION
Cardiac involvement was observed in recovered COVID-19 patients with no preexisting cardiovascular disease, no cardiovascular symptoms, and elevated serologic markers of myocardial injury during the whole course of COVID-19.
LEVEL OF EVIDENCE
1 TECHNICAL EFFICACY: Stage 5.
背景
在未经选择或伴有持续性心脏症状的康复 2019 冠状病毒病（COVID-19）患者中，磁共振成像发现心肌损伤。
目的
评估无心血管症状和住院期间异常血清学标志物的康复 COVID-19 患者是否存在心肌受累。
研究类型
前瞻性。
人群
21 名康复 COVID-19 患者和 20 名健康对照者（HC）。
磁场强度/序列：3.0T，电影，T2 加权成像，T1 映射和 T2 映射。
评估
心脏心室功能包括舒张末期容积、收缩末期容积、心排量、左心室（LV）质量和射血分数（EF）的 LV 和右心室（RV），以及节段性心肌 T1 和 T2 值。
统计学检验
采用学生 t 检验、单变量一般线性模型检验和卡方检验进行两组间分析。采用单因素方差分析或 Kruskal-Wallis H 检验对三组间进行分析，然后进行事后分析。
结果
15 名（71.43%）COVID-19 患者的磁共振检查结果异常，包括心肌固有 T1 值升高（5 例，23.81%）和 T2 值升高（10 例，47.62%）、LVEF 降低（1 例，4.76%）和 RVEF 降低（2 例，9.52%）。COVID-19 患者的节段性心肌 T2 值（49.20[46.1，54.6]msec）明显高于 HC（48.3[45.2，51.7]msec）（P<0.001），而心肌固有 T1 值在 COVID-19 患者和 HC 之间无显著差异。严重 COVID-19 患者的心肌 T2 值（52.5[48.1，57.1]msec）明显高于非严重 COVID-19 患者（48.8[45.9，53.8]msec）和 HC（48.3[45.2，51.7]msec）（P<0.001）。D-二聚体、C 反应蛋白或淋巴细胞减少异常升高的 COVID-19 患者的心肌 T2 值高于无异常升高者（均 P<0.05）。
数据结论
在整个 COVID-19 病程中，无预先存在的心血管疾病、无心血管症状和心肌损伤的血清学标志物升高的康复 COVID-19 患者中观察到心脏受累。
证据水平
1 技术功效：第 5 阶段。
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