Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement.
Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement.
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疑似心脏受累的COVID-19患者CMR心肌损伤
DOI：
10.1016/j.jcmg.2022.10.021
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发表时间：
2023-05
影响因子：
14
通讯作者：
Han, Yuchi
中科院分区：
文献类型：
--
作者：
Vidula, Mahesh K.;Rajewska-Tabor, Justyna;Cao, J. Jane;Kang, Yu;Craft, Jason;Mei, Winifred;Chandrasekaran, Preethi S.;Clark, Daniel E.;Poenar, Ana-Maria;Gorecka, Miroslawa;Malahfji, Maan;Cowan, Eilidh;Kwan, Jennifer M.;Reinhardt, Samuel W.;Al-Tabatabaee, Sarah;Doeblin, Patrick;Villa, Adriana D. M.;Karagodin, Ilya;Alvi, Nazia;Christia, Panagiota;Spetko, Nicholas;Cassar, Mark Philip;Park, Christine;Nambiar, Lakshmi;Turgut, Alper;Azad, Mahan Roosta;Lambers, Moritz;Wong, Timothy C.;Salerno, Michael;Kim, Jiwon;Elliott, Michael;Raman, Betty;Neubauer, Stefan;Tsao, Connie W.;LaRocca, Gina;Patel, Amit R.;Chiribiri, Amedeo;Kelle, Sebastian;Baldassarre, Lauren A.;Shah, Dipan J.;Hughes, Sean G.;Tong, Matthew S.;Pyda, Malgorzata;Simonetti, Orlando P.;Plein, Sven;Han, Yuchi
对COVID-19和疑似心脏受累患者的心肌损伤尚不清楚。本研究的目的是描述一个多中心队列的COVID-19患者的心肌损伤特征，这些患者疑似心脏受累，转诊进行心脏磁共振（CMR）。这项回顾性研究包括来自18个国际研究中心的1，047名经聚合酶链反应证实的COVID-19感染并接受CMR的患者。心肌损伤的特点是急性心肌炎，非急性/非缺血，急性缺血，非急性/缺血模式的CMR。在该队列中，20.9%的患者具有非缺血性损伤模式（急性心肌炎：7.9%;非急性/非缺血性：13.0%），6.7%的患者具有缺血性损伤模式（急性缺血性：1.9%;非急性/缺血性：4.8%）。在单变量分析中，与急性心肌炎模式相关的变量包括胸部不适（OR：2.00; 95%CI：1.17-3.40，P = 0.01），心电图（ECG）异常（OR：1.90; 95%CI：1.12-3.23; P = 0.02），利钠肽升高（OR：2.99; 95% CI：1.60-5.58; P = 0.0006），肌钙蛋白升高（OR：4.21; 95% CI：2.41-7.36; P < 0.0001）。与急性缺血模式相关的变量包括胸部不适（OR：3.14; 95%CI：1.04-9.49; P = 0.04），ECG异常（OR：4.06; 95% CI：1.10-14.92; P = 0.04），已知冠心病（OR：33.30; 95%CI：4.04-274.53; P = 0.001），住院治疗（OR：4.98; 95%CI：1.55-16.05; P = 0.007），利钠肽升高（OR：4.19; 95% CI：1.30-13.51; P = 0.02），肌钙蛋白升高（OR：25.27; 95% CI：5.55-115.03; P < 0.0001）。在多变量分析中，肌钙蛋白升高与急性心肌炎模式密切相关（OR：4.98; 95%CI：1.76-14.05; P = 0.003）。在这项针对临床怀疑心脏受累转介CMR的COVID-19患者的多中心研究中，当出现心脏症状、ECG异常和心脏生物标志物升高时，非缺血性和缺血性模式很常见。
Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood. The purpose of this study was to characterize myocardial injury in a multicenter cohort of patients with COVID-19 and suspected cardiac involvement referred for cardiac magnetic resonance (CMR). This retrospective study consisted of 1,047 patients from 18 international sites with polymerase chain reaction–confirmed COVID-19 infection who underwent CMR. Myocardial injury was characterized as acute myocarditis, nonacute/nonischemic, acute ischemic, and nonacute/ischemic patterns on CMR. In this cohort, 20.9% of patients had nonischemic injury patterns (acute myocarditis: 7.9%; nonacute/nonischemic: 13.0%), and 6.7% of patients had ischemic injury patterns (acute ischemic: 1.9%; nonacute/ischemic: 4.8%). In a univariate analysis, variables associated with acute myocarditis patterns included chest discomfort (OR: 2.00; 95% CI: 1.17-3.40, P = 0.01), abnormal electrocardiogram (ECG) (OR: 1.90; 95% CI: 1.12-3.23; P = 0.02), natriuretic peptide elevation (OR: 2.99; 95% CI: 1.60-5.58; P = 0.0006), and troponin elevation (OR: 4.21; 95% CI: 2.41-7.36; P < 0.0001). Variables associated with acute ischemic patterns included chest discomfort (OR: 3.14; 95% CI: 1.04-9.49; P = 0.04), abnormal ECG (OR: 4.06; 95% CI: 1.10-14.92; P = 0.04), known coronary disease (OR: 33.30; 95% CI: 4.04-274.53; P = 0.001), hospitalization (OR: 4.98; 95% CI: 1.55-16.05; P = 0.007), natriuretic peptide elevation (OR: 4.19; 95% CI: 1.30-13.51; P = 0.02), and troponin elevation (OR: 25.27; 95% CI: 5.55-115.03; P < 0.0001). In a multivariate analysis, troponin elevation was strongly associated with acute myocarditis patterns (OR: 4.98; 95% CI: 1.76-14.05; P = 0.003). In this multicenter study of patients with COVID-19 with clinical suspicion for cardiac involvement referred for CMR, nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present.
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影响因子：
24
作者：
Puntmann, Valentina O.;Carerj, M. Ludovica;Nagel, Eike
通讯作者：
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DOI：
10.1016/j.jcmg.2021.08.021
发表时间：
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期刊：
JACC. Cardiovascular imaging
影响因子：
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