Cardiac compromise in patients recovered from COVID-19 without troponin elevation assessed by cardiac magnetic resonance imaging

Adrián Carlessi, Departamento de Imágenes Cardiacas No Invasivas, Servicio de Diagnóstico por Imágenes, Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Leonel Perello, Departamento de Imágenes Cardiacas No Invasivas, Servicio de Diagnóstico por Imágenes, Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Cristian Pantaley, Servicio de Cardiología, Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Armando Borsini, Servicio de Cardiología, Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Lucía Rossi, Servicio de Cardiología, Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Florencia Giménez, Servicio de Cardiología, Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Julián Leonardi, Servicio de Cardiología, Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Ariel Ballina, Departamento de Neumonología y Alergia. Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Martin Maillo, Departamento de Neumonología y Alergia. Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Paula Di-Rienzo, Departamento de Neumonología y Alergia. Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Paula Gonzalo, Departamento de Neumonología y Alergia. Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Martín González-Vara, Departamento de Neumonología y Alergia. Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Luciana Vegetti, Departamento de Neumonología y Alergia. Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Sebastián Wustten, Departamento de Neumonología y Alergia. Hospital José María Cullen, Santa Fe Capital, Santa Fe, Argentina
Lucas Costa, Facultad de Ciencias Médicas, Universidad Nacional del Litoral, Santa Fe Capital, Santa Fe, Argentina
Diego Vergara, Servicio de Diagnostico por Imágenes, Hospital José María Cullen. Santa Fe Capital, Santa Fe, Argentina
Cristian Froullet, Servicio de Diagnostico por Imágenes, Hospital José María Cullen. Santa Fe Capital, Santa Fe, Argentina

Background: The disease caused by coronavirus (COVID-19) affects the cardiovascular system, whether by direct viral aggression or indirectly through systemic inflammation and multiple organ compromise. A widely used method to determine cardiac injury is troponin measurement. Objective: The aim of this study is to evaluate the prevalence of cardiac involvement (CINV) in a population recovered from COVID-19, referred to cardiac MRI (CMR), who did not present troponin elevation. Methods: There were 156 patients that recovered from COVID-19 and who did not present troponin elevation referred to CMR. CINV was considered to be the presence of: late gadolinium enhancement (LGE), edema, myocarditis, pericarditis, left ventricular systolic dysfunction (LVSD) and/or depressed right ventricular systolic dysfunction (RVSD). Results: Prevalence of CINV was 28.8%, being more frequent in men (p = 0.002), in patients who required hospitalization (p = 0.04) and in those who experienced non-mild cases of infection (p = 0.007). RVSD (17.9%) and LVSD (13.4%) were the most frequent findings. The rate of myocarditis was 0.6%. LGE manifested in 7.1% of patients and its presence was related to less left ventricular ejection fraction (LVEF) (p = 0.0001) and right ventricular ejection fraction (RVEF) (p = 0.04). Conclusion: In patients who recovered from COVID-19, 28.8% of CINV was found. It was more frequent in men, in patients who required admission and in patients with cases of non-mild infection. The patients that presented LGE had less LVEF and RVSF.

Keywords: COVID-19. Cardiac magnetic resonance. Late gadolinium enhancement. Troponins.