key: cord-0751302-4a3vyh82
authors: Blankstein, Ron; Chandrashekhar, Y.
title: New Insights on COVID-19 and the Heart
date: 2021-03-01
journal: JACC Cardiovasc Imaging
DOI: 10.1016/j.jcmg.2021.01.010
sha: 53c9e17b701286ac268aafa65dd6f7981b0fdf36
doc_id: 751302
cord_uid: 4a3vyh82

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, as well as identifying patients who have a worse prognosis (3, 4) . Although the amount of scientific data that have emerged on this topic in <1 year has been astonishing, understanding the generalizability and clinical implications of the various reported studies has been challenging. A common limitation to most imaging studies has been that there is significant referral bias that determines which individuals undergo imaging. Moreover, differences in imaging techniques, study timing, and the severity of COVID-19 among participants have varied widely.

A cohort study of German patients who recovered from COVID-19 suggested that cardiac involvement by cardiac magnetic resonance (CMR) using late gadolinium enhancement as well as native T 1 and T 2 mapping was common and occurred in 78% of patients (5) .

In this cohort, imaging was performed at a median duration of 71 days after infection. The findings of this study led to wide concern regarding the potential implications of myocarditis, a condition that seems to be subclinical in many individuals and often not associated with any impairment in systolic function. Both scientists and laypersons asked whether a pandemic that causes myocardial fibrosis would lead to a future wave of patients with arrhythmias, heart muscle dysfunction, or even sudden cardiac death. This concern became even more amplified among athletes in whom myocarditis has long been recognized as a potential cause of sudden cardiac death.

However, the high burden of myocarditis has not been confirmed in other studies. While an assorted variety of CMR abnormalities are fairly common in patients recovering from COVID-19 (6), strong evidence for myocarditis has been much more scarce in both pathologic and imaging studies (7-9) in patients dying or recovering from COVID-19.

One of the first comprehensive study on student athletes (10) provided further insights on the impact of COVID-19 on athletes' hearts by presenting data on 48 student athletes from West Virginia University who recovered from COVID-19 and who were referred for CMR testing. Per institutional protocol, CMR was only performed in the presence of symptoms (n ¼ 37) or abnormalities on electrocardiography (ECG) (n ¼ 1) or echocardiography (n ¼ 10).

Among the 48 athletes who were referred to CMR, 27 (56%) had cardiac abnormalities, with 19 (40%) having late gadolinium enhancement of the pericardium, which commonly involved the pericardium overlying the lateral wall and which was often associated with small pockets of pericardial effusion. However, isolated myocardial involvement was less frequent (17%) and was nonspecific as it did not involve alterations in both T 1 

ACC Imaging Council. Multimodality cardiovascular imaging in the midst of the COVID-19 pandemic: ramping up safely to a new normal

Expert Panel From the ACC Cardiovascular Imaging Leadership Council. Multimodality imaging in evaluation of cardiovascular complications in patients with COVID-19: JACC Scientific Expert Panel

Characterization of myocardial injury in patients with COVID-19

Prognostic value of right ventricular longitudinal strain in patients with COVID-19

Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19)

Cardiac involvement in patients recovered from covid-2019 identified using magnetic resonance imaging