1350207 - Follow-up of symptomatic patients with post-COVID-19 syndrome and pathologic findings on baseline exams by CMR reveals continuing mild myocardial alterations

After an acute infection with COVID-19 many patients suffer from symptoms for more than 12 weeks termed post-COVID-19 syndrome (pCov) (1). Due to the high burden of cardiologic complaints, including chest pain, dyspnea, palpitations, cardiac involvement is often thought of. Whether cardiac injury is an underlying mechanism is currently under investigation with contradictory results. Proposed mechanisms include chronic myocardial inflammation (2) or potential overlap with chronic fatigue syndrome (1) with no cardiac alterations (3).This study aimed at identifying whether myocardial alterations on baseline CMR examinations (bCMR) in pCov patients change on follow-up.

Methods:

Patients diagnosed with pCov and continuous symptoms who showed an impairment of myocardial function and/or signs of myocardial injury on bCMR (4) were followed-up by CMR. In total 39 patients, median age (interquartile range (IQR)) 42 (34-52) years, 30 females, were rescanned due to following findings on bCMR: impaired left ventricular (LV) function 2/39 (5%), impaired right ventricular (RV) function 17/39 (44%), late gadolinium enhancement (LGE) revealing myocardial focal scars16/39 (41%), elevated native T1 times 16/39 (41%), elevated extracellular volume 17/39 (44%) or elevated T2 times 4/39 (10%.) The bCMR were carried out at 77 (47-153) days after acute infection with follow-ups at 172 (106-269) days after initial diagnosis and 63 (46-110) days after bCMR. All subjects underwent a CMR study in a 1.5T scanner (Siemens) with a scan protocol including cine images in 3 long-axis and short axis (SAX) for function and strain analysis by feature tracking and complete SAX coverage for T1 and T2 mapping. Analysis was carried out with dedicated software (CVI⁴²). For function and parametric analysis global values as well as cases with values above the laboratory cutoffs (native T1 >1037 ms and T2 >54 ms) were reported.

Results:

At follow-up all myocardial function and tissue parameters for the entire cohort, except global radial strain (GRS) as well as global circumferential strain (GCS), showed no significant differences (Figure 1). In patients with LGE at baseline (N=16), both GRS as well as GCS improved. Compared on an individual patient level, no significant changes regarding impaired LV and RV function were noted. Similarly in patients with elevated native T1 and T2 times on bCMR, no significant changes were found (Table 1 and Figure 2).

Conclusion:

Follow-up of pCov patients with persistent symptoms after a median of 6 months who showed pathologic findings on baseline scans, revealed no changes in myocardial function and tissue characteristics. Fibrotic changes, indicated by native T1 and LGE, persist after the acute infection. Only parameters of myocardial deformation, GCS and GRS, seem to show an improvement in patients with LGE findings, potentially providing a marker for follow-ups.