Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging
Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging
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DOI：
10.1016/j.jcmg.2020.05.004
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发表时间：
2020-11-01
影响因子：
14
通讯作者：
Xia, Liming
中科院分区：
文献类型：
--
作者：
Huang, Lu;Zhao, Peijun;Xia, Liming
目的 本研究使用心脏磁共振 (CMR) 评估了 2019 年冠状病毒病 (COVID-19) 康复患者的心脏受累情况。 背景 此前曾报道过住院患者因 COVID-19 引起的心肌损伤。目前尚不清楚患者从 COVID-19 康复后是否存在持续的心脏受累。方法 回顾性纳入 26 名报告心脏症状并接受 CMR 检查的从 COVID-19 康复的患者。 CMR 方案由常规序列（电影、T2 加权成像和晚期钆增强 [LGE]）和定量映射序列（T1、T2 和细胞外体积 [ECV] 映射）组成。对 COVID-19 后患者的水肿率和 LGE 进行了评估。定量评估心功能、自然T1/T2和ECV，并与对照进行比较。 结果 15例患者（58%）在常规CMR序列上出现异常CMR表现：14例（54%）患者发现心肌水肿，8例（31%）患者发现LGE。常规 CMR 结果呈阳性的患者发现右心室功能参数下降，包括射血分数、心脏指数和每搏输出量/体表面积。使用定量图谱发现，与没有阳性结果和对照的患者相比，常规 CMR 结果呈阳性的患者的整体原生 T1、T2 和 ECV 均显着升高（中位数[四分位距]：原生 T1 1,271 毫秒 [1,243 至 1,298 毫秒] 对比 1,237 毫秒 [1,216 至 1,262 毫秒] 对比 1,224 毫秒 [1,217 至 1,262 毫秒] 1,245 ms]；平均值 +/- SD：T2 42.7 +/- 3.1 ms 与 38.1 ms +/- 2.4 与 39.1 ms +/- 3.1；中位数[四分位数范围]：28.2% [24.8% 至 36.2%] 与 24.8% [23.1% 至 25.4%] 与 23.7% [分别为 22.2% 至 25.2%]；p = 0.002；p < 0.001 和 p = 0.002）。 结论 在部分从 COVID-19 中康复的患者中发现了心脏受累。 CMR 表现包括心肌水肿、纤维化和右心室功能受损。对于有心脏症状的 COVID-19 康复患者，应注意可能的心肌受累。 (C) 2020 年，美国心脏病学会基金会。
OBJECTIVES This study evaluated cardiac involvement in patients recovered from coronavirus disease-2019 (COVID-19) using cardiac magnetic resonance (CMR).BACKGROUND Myocardial injury caused by COVID-19 was previously reported in hospitalized patients. It is unknown if there is sustained cardiac involvement after patients' recovery from COVID-19.METHODS Twenty-six patients recovered from COVID-19 who reported cardiac symptoms and underwent CMR examinations were retrospectively included. CMR protocols consisted of conventional sequences (cine, T2-weighted imaging, and late gadolinium enhancement [LGE]) and quantitative mapping sequences (T1, T2, and extracellular volume [ECV] mapping). Edema ratio and LGE were assessed in post-COVID-19 patients. Cardiac function, native T1/T2, and ECV were quantitatively evaluated and compared with controls.RESULTS Fifteen patients (58%) had abnormal CMR findings on conventional CMR sequences: myocardial edema was found in 14 (54%) patients and LGE was found in 8 (31%) patients. Decreased right ventricle functional parameters including ejection fraction, cardiac index, and stroke volume/body surface area were found in patients with positive conventional CMR findings. Using quantitative mapping, global native T1, T2, and ECV were all found to be significantly elevated in patients with positive conventional CMR findings, compared with patients without positive findings and controls (median [interquartile range]: native T1 1,271 ms [1,243 to 1,298 ms] vs. 1,237 ms [1,216 to 1,262 ms] vs. 1,224 ms [1,217 to 1,245 ms]; mean +/- SD: T2 42.7 +/- 3.1 ms vs. 38.1 ms +/- 2.4 vs. 39.1 ms +/- 3.1; median [interquartile range]: 28.2% [24.8% to 36.2%] vs. 24.8% [23.1% to 25.4%] vs. 23.7% [22.2% to 25.2%]; p = 0.002; p < 0.001, and p =0.002, respectively).CONCLUSIONS Cardiac involvement was found in a proportion of patients recovered from COVID-19. CMR manifestation included myocardial edema, fibrosis, and impaired right ventricle function. Attention should be paid to the possible myocardial involvement in patients recovered from COVID-19 with cardiac symptoms. (C) 2020 by the American College of Cardiology Foundation.