key: cord-0814256-507p0q7q
authors: Esposito, Antonio; Palmisano, Anna; Natale, Luigi; Ligabue, Guido; Peretto, Giovanni; Lovato, Luigi; Vignale, Davide; Fiocchi, Federica; Marano, Riccardo; Russo, Vincenzo
title: Cardiac Magnetic Resonance characterization of myocarditis-like acute cardiac syndrome in COVID-19
date: 2020-06-24
journal: JACC Cardiovasc Imaging
DOI: 10.1016/j.jcmg.2020.06.003
sha: 8d03e9fd99a87307315c75b3d1f67e8ebf2ef237
doc_id: 814256
cord_uid: 507p0q7q

nan

Novel coronavirus infection causes a systemic disease (COVID-19) with most frequent respiratory involvement. Beside systemic and respiratory complications, COVID-19 can reveal itself as a myocarditis-like syndrome (AMCovS), whose underliyng mechanism is largely unknown. A limited number of case reports have described Cardiac Magnetic Resonance (CMR) findings in AMCovS, only 2 of them including mapping (1, 2) .

Here we report the first series of AMCovS patients (n=10, F=8, age 52±6 years-old) consecutively referred for CMR for a suspected myocarditis, between March 15 and April 20, 2020, in four University Italian Hospitals. Local Ethical Committes approved or weived specific study approval, and the study was conducted according to Helsinki declaration. Eight out of 10 patients (80%) suffered from oppressive chest pain. The remaining 2 patients suffered from dyspnea. All the patients had unremarkable cardiological history and a low rate (Figure 1 ). Extracellular Volume fraction (ECV) was only available for 2/10 cases. In both cases the ECV was elevated (30% and 36% respectively) as was native-T1 and T2. Two patients had borderline wall thickening (wall thickness 13 mm in both cases) in regions of intense edema and mild dysfunction.

Mild pericardial effusion was present in 6/8 (75%) patients (median 5 mm [IQR, 3-11 mm]), without evidence of pericardial thickening (≤ 3mm).

Surprisingly, LGE was unremarkable (median 0% [IQR, 0.00-0.02%]). LGE was completely negative in 5 out of 8 patients. In the remaining 3 patients few thin and shadowed subepicardial striae of LGE were detectable in the lateral wall, accounting for 1%, 3% and 3% of LV mass respectively (Figure 1 ).

Based on updated 2018 Lake Louise Criteria, CMR findings, including T1 and T2 myocardial markers, resulted diagnostic for acute myocarditis in all the 8 patients. 

Acute myocarditis presenting as a reverse

Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection

Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)

Myocardial localization of coronavirus in COVID-19 cardiogenic shock