Boparai Montek S, Musheyev Benjamin, Khan Umair, Koduru Tejaswi, Hinson Jared, Skopicki Hal A, Duong Tim Q
Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
Rev Cardiovasc Med. 2022 Nov 30;23(12):389. doi: 10.31083/j.rcm2312389. eCollection 2022 Dec.
Many COVID-19 survivors experience persistent COVID-19 related cardiac abnormalities weeks to months after recovery from acute SARS-CoV-2 infection. Non-invasive cardiac magnetic resonance (CMR) imaging is an important tool of choice for clinical diagnosis of cardiac dysfunctions. In this systematic review, we analyzed the CMR findings and biomarkers of COVID-19 related cardiac sequela after SARS-CoV-2 infection.
Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), we conducted a systematic review of studies that assessed COVID-19 related cardiac abnormalities using cardiovascular magnetic resonance imaging. A total of 21 cross-sectional, case-control, and cohort studies were included in the analyses.
Ten studies reported CMR results 3 months after SARS-CoV-2 infection and 11 studies 3 months after SARS-CoV-2 infection. Abnormal T1, abnormal T2, elevated extracellular volume, late gadolinium enhancement and myocarditis was reported less frequently in the 3-month studies. Eight studies reported an association between biomarkers and CMR findings. Elevated troponin was associated with CMR pathology in 5/6 studies, C-reactive protein in 3/5 studies, N-terminal pro-brain natriuretic peptide in 1/2 studies, and lactate dehydrogenase and D-dimer in a single study. The rate of myocarditis via CMR was 18% (154/868) across all studies. Most SARS-CoV-2 associated CMR abnormalities resolved over time.
There were CMR abnormalities associated with SARS-CoV-2 infection and most abnormalities resolved over time. A panel of cardiac injury and inflammatory biomarkers could be useful in identifying patients who are likely to present with abnormal CMR pathology after COVID-19. Multiple mechanisms are likely responsible for COVID-19 induced cardiac abnormalities.
许多新冠病毒疾病（COVID-19）幸存者在从急性严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染中康复数周甚至数月后，仍存在与COVID-19相关的持续性心脏异常。非侵入性心脏磁共振（CMR）成像检查是临床诊断心脏功能障碍的重要选择工具。在本系统评价中，我们分析了SARS-CoV-2感染后与COVID-19相关的心脏后遗症的CMR检查结果和生物标志物。
按照系统评价和Meta分析的首选报告项目（PRISMA），我们对使用心血管磁共振成像评估COVID-19相关心脏异常的研究进行了系统评价。分析共纳入21项横断面研究、病例对照研究和队列研究。
10项研究报告了SARS-CoV-2感染3个月后的CMR检查结果，11项研究报告了SARS-CoV-2感染3个月后的情况。在感染3个月后的研究中，T1异常、T2异常、细胞外容积升高、钆延迟增强和心肌炎的报告频率较低。8项研究报告了生物标志物与CMR检查结果之间的关联。在5/6的研究中，肌钙蛋白升高与CMR病理改变相关，在3/5的研究中C反应蛋白与之相关，在1/2的研究中N末端脑钠肽前体与之相关，在单项研究中乳酸脱氢酶和D-二聚体与之相关。所有研究中通过CMR检查诊断心肌炎的比例为18%（154/868）。大多数与SARS-CoV-2相关的CMR异常会随着时间推移而消失。
存在与SARS-CoV-2感染相关的CMR异常，且大多数异常会随着时间推移而消失。一组心脏损伤和炎症生物标志物可能有助于识别COVID-19后可能出现CMR病理异常的患者。多种机制可能导致COVID-19引起的心脏异常。
