Prospective Cardiac MRI study comparing Recovered COVID-19 patients with Recovered Non-COVID-19 Viral Respiratory Infection Patients (R-COVID-CMR).

OBJECTIVE

Coronavirus disease 2019 (COVID-19) has been associated with subclinical myocardial inflammation. Post-COVID-19 infection, there are concerns about subsequent heart failure and persistent myocarditis. It is unknown how COVID-19 infection compares with non-COVID-19 viral infections in terms of myocardial inflammation based on cardiovascular magnetic resonance (CMR) assessment. This prospective longitudinal study aims to determine and compare the extent and severity of myocardial involvement in patients with COVID-19 infection versus non-COVID-19 viral respiratory infections (control).

METHOD: Recruited recovered COVID-19 (RCOVID) patients and recovered non-COVID (non-COVID) patients from several hospitals and COVID-19-designated clinic underwent three CMR examinations for functional assessment, native T1, T2, and extracellular volume (ECV) quantification, with corroborating blood markers (NT-proBNP, white cell count, c-reactive protein, lactate dehydrogenase, and high sensitivity cardiac troponin T). CMR scans took place (i) within 2-week of confirmed recovery, (ii) 3-month, and (iii) 12-month post-recovery. Linear mixed model with Bonferroni correction was used for analysis.

RESULTS

152 participants were recruited, 112 RCOVID outpatients (mean age: 41.0; 58.9% female) and 40 non-COVID inpatients (mean age:45.0; 37.5% female). Non-COVID infections included influenza virus, rhinovirus/enterovirus, parainfluenza virus, respiratory syncytial virus, and human metapneumovirus. At all three time points, blood results and cardiac function parameters were not significantly different between RCOVID and non-COVID patient groups (p-value not significant). Both patient groups had no significant differences for native T1/T2 values, ECV, late gadolinium enhancement, T2 short tau inversion recovery, and overall fulfilment of the 2018 revised Lake Louise Criteria at each time points.

CONCLUSION

In this prospective longitudinal study with CMR examinations, COVID-19 infection does not cause a worse myocardial inflammatory response than non-COVID-19 viral respiratory infection in terms of CMR parameters, and blood markers.

PLAIN ENGLISH SUMMARY: During the coronavirus disease 2019 (COVID-19) outbreaks, some COVID-19 patients were incidentally found to have inflammation of the muscular layer of the heart. Healthcare professionals were concerned the inflammation will lead to heart not delivering enough blood to meet body demands (ie. heart failure) in the long run. Therefore, we designed this study to better understand the extent and severity of cardiac involvement in patients with COVID-19 by comparing them to patients with other types of viral respiratory infections, such as influenza, which we were more familiar with. We recruited two groups of patients, one group with patients recovered from COVID-19, the other group with patients recovered from other types of viral respiratory infections. For each patient, we arranged three assessments at 2 weeks, 3 months, and 12 months after their recovery respectively. During each assessment, they had blood taken and underwent a cardiovascular magnetic resonance (CMR) scan, a type of medical imaging used for assessment of heart function. 2018 revised Lake Louise Criteria (LLC) is a set of criteria for diagnosis of myocardial inflammation recommended by a group of experts. We compared the two groups of patients at each time point according to LLC, as well as their blood markers and heart function. In our study, we found that COVID-19 infection does not cause a worse heart muscle inflammatory response than other types of viral respiratory infections. This is reassuring as patients with previous COVID-19 infections will likely not develop inflammation of the heart muscle nor develop heart failure.