Cardiovascular Magnetic Resonance Feature Tracking in Assessing Myocardial Strain Post COVID-19 Recovery


Coronavirus disease 2019 (COVID-19) has emerged as a global health crisis, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as its causative agent. Beyond its primarily respiratory impact, COVID-19 has been associated with diverse organ involvement, including notable cardiac complications.

Myocardial injury, occurring in a significant percentage of cases, has been linked to adverse outcomes, prompting research into its underlying mechanisms and potential long-term consequences.

This article explores the intricate relationship between COVID-19 and cardiac health, with a focus on myocardial strain as assessed through Cardiovascular Magnetic Resonance (CMR) feature tracking. Myocardial strain is a crucial parameter in evaluating cardiac function, and its alteration in COVID-19 survivors could offer insights into post-infection care strategies.

Introduction: Unraveling the Cardiac Mysteries of COVID-19

COVID-19’s impact on the cardiovascular system goes beyond respiratory distress, with a range of cardiac complications, including heart failure and myocardial injury. Understanding the mechanisms behind these cardiac issues is crucial for developing effective post-COVID-19 care strategies.

The Enigma of Cardiac Injury in COVID-19

While the precise cause of cardiac injury in COVID-19 remains elusive, existing evidence points to inflammatory responses, cytokine storms, viral myocarditis, pericarditis, stress-induced cardiomyopathy, and microvascular thrombosis as potential contributors. Unraveling this enigma is imperative for comprehending the full spectrum of COVID-19’s impact on cardiac health.

Role of Cardiovascular Magnetic Resonance in Unraveling Cardiac Secrets

Cardiovascular magnetic resonance (CMR), particularly CMR feature tracking (CMR-FT), has become indispensable in diagnosing and characterizing cardiovascular pathologies. CMR-FT, which evaluates myocardial strain, emerges as a powerful tool to detect subtle cardiac dysfunction, making it a valuable asset for assessing the cardiovascular health of COVID-19 survivors.

Myocardial Strain in Post-COVID-19 Recovery: A Novel Perspective

This study, aiming to characterize myocardial strain in patients post-COVID-19 recovery, delves into CMR-derived ventricular and atrial strain parameters. The findings reveal significantly lower cardiac strain values in COVID-19 survivors compared to a control group. Remarkably, this study is the first to report lower atrial longitudinal strain values in this population.

Variability in Myocardial Strain Across COVID-19 Variants and Severity

Existing studies report variability in myocardial strain values across COVID-19 variants and severity. Some studies note lower values of global longitudinal strain (GLS) and global circumferential strain (GCS) in patients who recovered from COVID-19, particularly those with the delta variant. Severity of the disease during the active phase influences the time-dependent improvement of cardiac function, with differences observed between mild and severe cases.

Temporal Dynamics of Myocardial Strain Recovery

The temporal dynamics of myocardial strain recovery post-COVID-19 are complex. Studies indicate that 30 days after the initial diagnosis, GLS can detect subclinical left ventricular dysfunction. On the other hand, during the acute phase, abnormal myocardial mechanics manifest within 3 to 8 days, indicating lower peak GLS and a low rate of positive late gadolinium enhancement (LGE).

However, in the examined cohort around 30 days after recovery, cardiac strain values remained similar, raising questions about the persistent impact of COVID-19 on cardiac function.

Table 1

A positive late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a finding that indicates the presence of myocardial fibrosis. Myocardial fibrosis is a condition in which the heart muscle is replaced by scar tissue. This can happen as a result of a number of different conditions, including:

  • Ischemic heart disease (heart attack)
  • Non-ischemic cardiomyopathy (cardiomyopathy that is not caused by a heart attack)
  • Myocarditis (inflammation of the heart muscle)
  • Amyloidosis (a condition in which abnormal proteins build up in the heart muscle)

A positive LGE can be used to diagnose a variety of different heart conditions, including:

  • Hypertrophic cardiomyopathy (HCM)
  • Dilated cardiomyopathy (DCM)
  • Restrictive cardiomyopathy (RCM)
  • Arrhythmogenic cardiomyopathy (ACM)
  • Sarcoidosis (an inflammatory disease that can affect the heart and other organs)

A positive LGE can also be used to assess the severity of a heart condition and to predict the risk of future events, such as heart failure, arrhythmias, and sudden cardiac death.

In general, a positive LGE is associated with a worse prognosis than a negative LGE. However, the specific prognosis depends on the underlying heart condition and other factors, such as the patient’s age, symptoms, and other medical conditions.

If you have a positive LGE, your doctor will work with you to develop a treatment plan to manage your heart condition and reduce your risk of future complications. Treatment may include medications, lifestyle changes, and procedures such as surgery or implantation of a cardiac device.

Comparison with Echocardiography-Based Studies

Comparisons with echocardiography-based studies highlight differences in findings. While some studies report lower GLS in patients within two months of diagnosis, others show improvement after three months of hospital discharge. The discrepancy in results may stem from variations in study populations, timing of assessments, and differences in the severity of COVID-19 symptoms.

Lingering Cardiac Effects: Long-Term Implications of COVID-19

Lingering cardiac effects of COVID-19 extend beyond the acute phase, with evidence of cardiovascular sequelae persisting beyond the first month of illness. This study identifies late gadolinium enhancement (LGE) in a substantial percentage of patients, indicating ongoing myocardial involvement even after recovery.

Conclusion: A Multifaceted Approach to Post-COVID-19 Cardiac Care

In conclusion, this study sheds light on the intricate relationship between COVID-19 and cardiac health, emphasizing the role of myocardial strain assessment through CMR-FT. The findings underscore the importance of a multifaceted approach to post-COVID-19 cardiac care, considering the variability in strain values, temporal dynamics of recovery, and lingering cardiac effects. As we continue to unravel the complexities of COVID-19, integrating advanced imaging techniques like CMR-FT proves crucial for comprehensive patient management and improving long-term outcomes.

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