Schaustz Eduardo B, Secco José Carlos P, Barroso Julia M, Ferreira Juliana R, Tortelly Mariana B, Pimentel Adriana L, Figueiredo Ana Cristina B S, Albuquerque Denilson C, Sales Allan R Kluser, Rosado de-Castro Paulo H, Pinheiro Martha V T, Souza Olga F, Medei Emiliano, Luiz Ronir R, Silvestre-Sousa Andréa, Camargo Gabriel C, Moll-Bernardes Renata
D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil.
Int J Cardiol Heart Vasc. 2024 Aug 27;54:101499. doi: 10.1016/j.ijcha.2024.101499. eCollection 2024 Oct.
Concerns have been raised about cardiac inflammation in patients with long COVID-19, particularly those with myocardial injury during the acute phase of the disease. This study was conducted to examine myopericardial involvement, detected by cardiac magnetic resonance (CMR) imaging in patients hospitalized for COVID-19.
Adult patients hospitalized with COVID-19 who presented myocardial injury or increased D-dimers were enrolled in this prospective study. All patients were invited to undergo CMR imaging examination after discharge. During follow-up, patients with nonischemic myocardial or pericardial involvement detected on the first CMR imaging examination underwent second examinations. CMR imaging findings were compared with those of a control group of healthy patients with no comorbidity.
Of 180 included patients, 53 underwent CMR imaging examination. The mean age was 58.4 ± 18.3 years, and 73.6 % were male. Myocardial and pericardial LGE was reported in 43.4 % and 35.8 % of patients, respectively. Nonischemic myocardial or pericardial involvement was reported in 26 (49.1 %) patients. The prevalence of pericardial LGE was associated inversely with the interval between hospital discharge and CMR. COVID-19 survivors had higher end-systolic volume indices (ESVis) and lower left-ventricular ejection fractions than did healthy controls. Seventeen patients underwent follow-up CMR imaging; the end-diastolic volume index, ESVi, and prevalence of pericardial LGE, but not that of nonischemic LGE, were reduced.
Among COVID-19 survivors with myocardial injury during the acute phase of the disease, the incidences of nonischemic myocardial and pericardial LGE and CMR imaging-detected signs of cardiac remodeling, partially reversed during follow-up, were high.
长期感染新冠病毒（COVID-19）的患者，尤其是在疾病急性期出现心肌损伤的患者，其心脏炎症受到关注。本研究旨在通过心脏磁共振成像（CMR）检查，探究因COVID-19住院患者的心肌心包受累情况。
本前瞻性研究纳入了因COVID-19住院且出现心肌损伤或D-二聚体升高的成年患者。所有患者出院后均被邀请接受CMR成像检查。在随访期间，首次CMR成像检查发现有非缺血性心肌或心包受累的患者接受了第二次检查。将CMR成像结果与无合并症的健康对照组进行比较。
在纳入的180例患者中，53例接受了CMR成像检查。平均年龄为58.4±18.3岁，男性占73.6%。分别有43.4%和35.8%的患者出现心肌和心包延迟强化（LGE）。26例（49.1%）患者出现非缺血性心肌或心包受累。心包LGE的患病率与出院至CMR检查的间隔时间呈负相关。COVID-19幸存者的收缩末期容积指数（ESVi）高于健康对照组，左心室射血分数低于健康对照组。17例患者接受了随访CMR成像检查；舒张末期容积指数、ESVi和心包LGE的患病率降低，但非缺血性LGE的患病率未降低。
在疾病急性期出现心肌损伤的COVID-19幸存者中，非缺血性心肌和心包LGE以及CMR成像检测到的心脏重塑迹象的发生率较高，部分在随访期间有所逆转。
