Tissue Characterization

1350290 - Cardiovascular Magnetic Resonance Reveals Cardiac Inflammation and Fibrosis in Symptomatic Patients with Post-COVID-19 Syndrome: Findings from the INSPIRE-CMR Multicenter Study.

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

Sophie I. Mavrogeni, MD, PhD

Professor/Cardiologist
Onassis Cardiac Surgery Center, Athens, Greece and National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
Athens, Attiki, Greece

Primary Author(s)

GM

George Markousis-Mavrogenis, MD

Medical Doctor/Researcher
Olympic Diagnostic Center, Piraeus, Greece, Greece

Co-Author(s)

VV

Vasiliki Vartela, MD, PhD

Cardiologist
Onassis Cardiac Surgery Center, Athens, Greece, Greece
AP

Alesisa Pepe, MD, PhD

Professor/Cardiologist/Radiologist
Institute of Radiology, Department of Medicine, University of Padua
Padova, Veneto, Italy
Lilia M. Sierra-Galan, MD, FSCMR

Cardiologist
American British Cowdray Medical Center, Mexico City, Mexico
Mexico City, Mexico City, Mexico
EA

Emmanouel Androulakis, MD, PhD, MSc

Cardiologist
Royal Brompton Hospital, Imaging Centre, Guy’s and St Thomas’ NHS Foundation Trust, United Kingdom
London, United Kingdom
AP

Anna Perazzolo, MD

Radiology Resident
Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy and Institute of Radiology, Department of Diagnostic Imaging, University of Udine, Udine, Italy, Italy
AC

Aikaterini Christidi, MD, PhD

Cardiologist
Euromedica MRI Unit, Thessaloniki, Greece, Greece
AB

Antonios Belegrinos, MD

Medical Doctor
National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece, Greece
AG

Aikaterini Giannakopoulou, MD

Pediatric Cardiologist
Aghia Sophia Children Hospital, Athens, Greece, Greece
MB

Maria Bonou, MD, PhD

Cardiologist
Department of Cardiology, Laikon General Hospital, Athens, Greece, Greece
AV

Agathi-Rosa Vrettou, MD, PhD

Cardiologist
2nd Department of Cardiology, Attikon University Hospital, University of Athens, Athens, Greece, Greece
FL

Fotini Lazarioti, MD

Radiologist
Olympic Diagnostic Center, Piraeus, Greece, Greece
EP

Eleftheria Patsilinakou, BSc

Radiology Technologist
Olympic Diagnostic Center, Piraeus, Greece, Greece
PS

Paul Samantis, BSc

Radiology Technologist
Olympic Diagnostic Center, Piraeus, Greece, Greece
CZ

Chiara Zuiani, MD, PhD

Professor/Radiologist
Institute of Radiology, Department of Diagnostic Imaging, University of Udine, Udine, Italy, Italy
EQ

Emilio Quaia, MD, PhD

Professor/Radiologist
Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy, Italy
RM

Raad Mohiaddin, MD, PhD

Professor/Radiologist
Royal Brompton Hospital, Imaging Centre, Guy’s and St Thomas’ NHS Foundation Trust, United Kingdom and National Heart and Lung Institute, Imperial College London, London, United Kingdom
London, England, United Kingdom
Sophie I. Mavrogeni, MD, PhD

Professor/Cardiologist
Onassis Cardiac Surgery Center, Athens, Greece and National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
Athens, Attiki, Greece

Disclosure(s):

Sophie I. Mavrogeni, MD, PhD: No financial relationships to disclose

Lilia Sierra-Galan, MD, FSCMR: No financial relationships to disclose

Background: Convalescent patients with a history of coronavirus disease-2019 (COVID-19) may develop post-COVID-19 syndrome, which includes symptoms of dyspnea, palpitations, or chest pain. The prevalence of cardiac involvement in these patients is unknown, and whether their symptoms correspond to clinical conditions that require treatment is uncertain. We aimed to evaluate the findings of cardiovascular magnetic resonance (CMR) in convalescent patients with a history of COVID-19, referred due to cardiac symptoms. We thus conducted the INvestigation of Symptomatic patients with Post-COVID-19 syndrome using CMR (INSPIRE-CMR).

Methods: INSIPRE-CMR was a retrospective multicenter study of 174 patients from 5 centers. Patients were referred for CMR due to dyspnea, chest pain, palpitations, or syncope and underwent CMR in a 3.0T or 1.5T system (24%/76%, respectively). The presence of myocardial inflammation was determined using the updated Lake Louise criteria, comprised of a T1-criterion [any pathologic T1-index from early/late gadolinium enhancement (EGE/LGE), native T1 mapping, extracellular volume fraction (ECV)] and a T2-criterion (pathologic T2-myocardial to skeletal muscle ratio or T2 mapping). For the T1-criterion, only patients with ≥3/4 indices available were analyzed (145/174), while for the T2-criterion, any patients with ≥1 index available were analyzed (173/174). Cut-off points for abnormal values (respectively for 1.5T and 3.0T) were ≥1000/≥1250 ms for native T1 mapping and >52/ >50 for T2 mapping. Pathologic values for ECV, EGE, LGE and T2-ratio were >28%, >4, > 0% of left ventricular mass, and >2, respectively.

Results: Patients had a median age of 40 years (IQR: 26-54), 72 (41%) were women, and 17 (9.7%) had known autoimmune disease, muscular dystrophy, or cancer. Of 154 with known vaccination status, 116 (75%) were fully vaccinated against SARS-CoV-2, and the majority [148 (85%)] experienced COVID-19 of mild/moderate intensity. In total, 149 (86%) patients were LGE-positive and of those evaluated with the updated Lake Louise criteria, 141/145 (97%) had ≥1 pathologic T1 index. The T2-criterion was positive in 62/173 (36%) patients. Collectively, 48/145 (33%) patients had both a positive T1- and a positive T2-criterion (high probability of myocardial inflammation). A positive T1-criterion was not associated with a history of severe COVID-19 (p=0.355). However, the presence of a positive T2-criterion or a combination of a positive T1- and T2-criterion were significantly more common amongst patients that experienced severe COVID-19 [45 (31%) vs. 17 (65%), p=0.001 and 32 (27%) vs. 16 (64%), p< 0.001, respectively].

Conclusion: In convalescent patients with a history of COVID-19 and cardiac symptoms, CMR revealed abnormalities in T1-based indices in most patients, and a high probability of myocardial inflammation in ~1/3 patients. A history of severe COVID-19 was associated with a higher probability of abnormalities in T2-based indices alone or in combination with T1-based indices.