Gröschel Jan, Bhoyroo Yashraj, Blaszczyk Edyta, Trauzeddel Ralf Felix, Viezzer Darian, Saad Hadil, Fenski Maximilian, Schulz-Menger Jeanette
Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany.
Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany.
Front Cardiovasc Med. 2022 Jul 14;9:916922. doi: 10.3389/fcvm.2022.916922. eCollection 2022.
Myocarditis-like findings after COVID-19 (coronavirus disease 2019) infection and vaccination were reported by applying cardiovascular magnetic resonance (CMR). These results are very heterogenous and dependent on several factors such as hospital admission or outpatient treatment, timing of CMR, and symptomatic load. This retrospective study aimed to identify differences in myocardial damage in patients with persistent symptoms both after COVID-19 infection and vaccine by applying CMR.
This study entails a retrospective analysis of consecutive patients referred for CMR between August 2020 and November 2021 with persistent symptoms after COVID-19 infection or vaccination. Patients were compared to healthy controls (HC). All patients underwent a CMR examination in a 1.5-T scanner with a scan protocol including: cine imaging for biventricular function and strain assessment using feature tracking, T2 mapping for the quantification of edema, and T1 mapping for diffuse fibrosis and late gadolinium enhancement (LGE) for the detection and quantification of focal fibrosis. Patients were divided into a subacute COVID-19 (sCov) group with symptoms lasting < 12 weeks, post-COVID-19 (pCov) group with symptoms > 12 weeks, and patients after COVID-19 vaccination (CovVac).
A total of 162 patients were recruited of whom 141 were included for analysis. The median age in years (interquartile range (IQR)) of the entire cohort was 45 (37-56) which included 83 women and 58 men. Subgroups were as follows (total patients per subgroup, median age in years (IQR), main gender): 34 sCov, 43 (37-52), 19 women; 63 pCov, 52 (39-58), 43 women; 44 CovVac, 43 (32-56), 23 men; 44 HC (41 (28-52), 24 women). The biventricular function was preserved and revealed no differences between the groups. No active inflammation was detected by T2 mapping. Global T1 values were higher in pCov in comparison with HC (median (IQR) in ms: pCov 1002ms (981-1023) vs. HC 987ms (963-1009; = 0.005) with other parings revealing no differences. In 49/141 (34.6%) of patients, focal fibrosis was detectable with the majority having a non-ischemic pattern (43/141; 30.4%; patients) with the subgroups after infection having more often a subepicardial pattern compared with CovVac (total (% of group): sCov: 7/34(21%); pCov 13/63(21%); CovVac 2/44(5%); = 0.04).
Patients after COVID-19 infection showed more focal fibrosis in comparison with patients after COVID-19 vaccination without alterations in the biventricular function.
通过应用心血管磁共振（CMR）报告了2019冠状病毒病（COVID-19）感染和疫苗接种后出现的心肌炎样表现。这些结果非常异质，并且取决于几个因素，如住院或门诊治疗、CMR检查时间以及症状负荷。这项回顾性研究旨在通过应用CMR确定COVID-19感染和疫苗接种后持续有症状患者心肌损伤的差异。
本研究对2020年8月至2021年11月期间因COVID-19感染或疫苗接种后持续有症状而被转诊进行CMR检查的连续患者进行回顾性分析。将患者与健康对照（HC）进行比较。所有患者均在1.5-T扫描仪上进行CMR检查，扫描方案包括：用于双心室功能和使用特征跟踪进行应变评估的电影成像、用于水肿定量的T2映射、用于弥漫性纤维化的T1映射以及用于检测和定量局灶性纤维化的延迟钆增强（LGE）。患者被分为症状持续时间<12周的亚急性COVID-19（sCov）组、症状持续时间>12周 的COVID-19后（pCov）组以及COVID-19疫苗接种后（CovVac）组。
共招募了162例患者，其中141例纳入分析。整个队列的年龄中位数（四分位间距（IQR））为45岁（37 - 56岁），包括83名女性和58名男性。亚组情况如下（每个亚组的患者总数、年龄中位数（IQR）、主要性别）：34例sCov，43岁（37 - 52岁），19名女性；63例pCov，52岁（39 - 58岁），43名女性；44例CovVac，43岁（32 - 56岁），23名男性；44例HC（41岁（28 - 52岁），24名女性）。双心室功能得以保留，且各组之间无差异。通过T2映射未检测到活动性炎症。与HC相比，pCov组的整体T1值更高（以毫秒为单位的中位数（IQR）：pCov组为1002毫秒（981 - 1023），HC组为987毫秒（963 - 1009；P = 0.005），其他配对比较未显示差异。在141例患者中的49例（34.6%）可检测到局灶性纤维化，大多数具有非缺血模式（141例中的43例；30.4%；患者），与CovVac组相比，感染后的亚组更常出现心外膜下模式（各亚组总数（占组的百分比）：sCov组：7/34（21%）；pCov组：13/63（21%）；CovVac组：2/44（5%）；P = 0.04）。
与COVID-19疫苗接种后的患者相比，COVID-19感染后的患者出现更多局灶性纤维化，而双心室功能无改变。
