The Midterm Effects of COVID-19 on the Heart of a Healthy Population: A Cardiac MRI Study

Document Type : Original Article

Authors

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Multiple investigations have reported cardiac involvement in the early and late phases of COVID-19 infection. It is associated with notable morbidity and mortality. Early detection of cardiac involvement may render timely intervention, reducing residual myocardial injuries. We evaluated cardiac magnetic resonance imaging (MRI)-derived functional and inflammatory findings 3 to 6 months after acute COVID-19 infection in a healthy population recovered from the disease and compared them with normal controls.
 
Methods: Twenty cases with a definite history of respiratory COVID-19 infection, in the preceding 3 to 6 months and 28 age- and sex-matched healthy subjects were assessed. The non-contrast cardiac MRI findings of the 2 groups were compared. Moreover, pulmonary parenchymal involvement in the acute phase and its correlation with cardiac MRI findings were evaluated. Data analysis was performed with SPSS, version 22, and a P value of less than 0.05 was considered significant.
 
Results: Twenty subjects (mean ± SD of age = 35.30 ± 5.27 y; 55% female) with a definite history of COVID-19 infection and 28 healthy controls (mean ± SD of age = 31.07 ± 4.35 y; 50% female) were included. Biventricular ejection fraction, biventricular global longitudinal strain, right ventricular global circumferential strain, and right ventricular global radial strain were significantly different between the 2 groups. Six patients (30%) in the COVID-19 group exhibited regional myocardial edema. No significant linear correlations existed between the severity of pulmonary involvement and cardiac MRI parameters.
 
Conclusions: In the midterm follow-up of healthy patients after COVID-19 infection, a significant reduction was observed in myocardial strain and function, independent of the severity of lung disease. (Iranian Heart Journal 2024; 25(1): 19-26)

Keywords


  1. Fauvel C, Trimaille A, Weizman O, Pezel T, Mika D, Waldmann V, et al. Cardiovascular manifestations secondary to COVID-19: A narrative review. Respiratory Medicine and Research. 2022; 81:100904.
  2. Tobler DL, Pruzansky AJ, Naderi S, Ambrosy AP, Slade JJ. Long-Term Cardiovascular Effects of COVID-19: Emerging Data Relevant to the Cardiovascular Clinician. Current Atherosclerosis Reports. 2022:1-8.
  3. Hatab T, Moumneh MB, Akkawi AR, Ghazal M, Alam SE, Refaat MM. COVID-19: cardiovascular manifestations—a review of the cardiac effects. Journal of Geriatric Cardiology: JGC. 2022; 19(3):245.
  4. Asadian S, Hosseini L, Maadani M, Jahanshahi B, Rezaeian N. Two challenging cases with COVID heart. Clinical Case Reports. 2021; 9(1):241.
  5. Khaleghi M, Aziz-Ahari A, Rezaeian N, Asadian S, Mounesi Sohi A, Motamedi O, et al. The Valuable Role of Imaging Modalities in the Diagnosis of the Uncommon Presentations of COVID-19: An Educative Case Series. Case Reports in Medicine. 2021; 2021.
  6. Naderi N, Ansari Ramandi MM, Baay M, Hosseini Z, Zanganehfar ME, Rabieie P, et al. Cardiovascular patients in COVID‐19 era, a case series, an experience from a tertiary cardiovascular center in Tehran, Iran. Clinical Case Reports. 2020; 8(12):2436-42.
  7. Rezaeian N, Hosseini L, Asadian S. Cardiac magnetic resonance findings in coronavirus disease 2019. Clinical Case Reports. 2021; 9(4):2168.
  8. Katwa LC, Mendoza C, Clements M. CVD and COVID-19: Emerging Roles of Cardiac Fibroblasts and Myofibroblasts. Cells. 2022; 11(8):1316.
  9. Sanyaolu A, Marinkovic A, Prakash S, Zhao A, Balendra V, Haider N, et al. Post-acute Sequelae in COVID-19 Survivors: an Overview. SN Comprehensive Clinical Medicine. 2022; 4(1):1-12.
  10. Sifaat M, Patel P, Sheikh R, Ghaffar D, Vaishnav H, Nahar L, et al. Cardiorenal Disease in COVID-19 Patients. Journal of the Renin-Angiotensin-Aldosterone System. 2022; 2022.
  11. Welty FK, Rajai N, Amangurbanova M. Comprehensive review of cardiovascular complications of coronavirus disease 2019 and beneficial treatments. Cardiology in review. 2022; 30(3):145.
  12. Elseidy SA, Awad AK, Vorla M, Fatima A, Elbadawy MA, Mandal D, et al. Cardiovascular complications in the Post-Acute COVID-19 syndrome (PACS). IJC Heart & Vasculature. 2022; 40:101012.
  13. Clark DE, Aggarwal SK, Phillips NJ, Soslow JH, Dendy JM, Hughes SG. Cardiac Magnetic Resonance in the Evaluation of COVID-19. Cardiac Failure Review. 2022;8.
  14. Dweck MR, Bularga A, Hahn RT, Bing R, Lee KK, Chapman AR, et al. Global evaluation of echocardiography in patients with COVID-19. European Heart Journal-Cardiovascular Imaging. 2020;21(9):949-58.
  15. Jafari F, Safaei AM, Hosseini L, Asadian S, Kamangar TM, Zadehbagheri F, et al. The role of cardiac magnetic resonance imaging in the detection and monitoring of cardiotoxicity in patients with breast cancer after treatment: a comprehensive review. Heart Failure Reviews. 2021; 26(3):679-97.
  16. Sharifian M, Rezaeian N, Asadian S, Mohammadzadeh A, Nahardani A, Kasani K, et al. Efficacy of novel noncontrast cardiac magnetic resonance methods in indicating fibrosis in hypertrophic cardiomyopathy. Cardiology Research and Practice. 2021; 2021.
  17. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. Journal of the American College of Cardiology. 2009; 53(17):1475-87.
  18. Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). European radiology. 2020; 30(8):4407-16.
  19. Rezaeian N, Rabiei P, Manshouri S, Hosseini L, Toloueitabar Y, Motevalli M, et al. Pulmonary Computed Tomography Hallmarks and the Short-term Outcome of COVID-19 Pneumonia in Patients with an Underlying Cardiovascular Disease. European Journal of Molecular & Clinical Medicine. 2021; 8(1):2021.
  20. Samidurai A, Das A. Cardiovascular complications associated with COVID-19 and potential therapeutic strategies. International journal of molecular sciences. 2020; 21(18):6790.
  21. Kato S, Azuma M, Fukui K, Kodama S, Nakayama N, Kitamura H, et al. Cardiac involvement in coronavirus disease 2019 assessed by cardiac magnetic resonance imaging: a meta-analysis. Heart and vessels. 2022:1-13.
  22. Carlessi A, Perello L, Pantaley C, Borsini A, Rossi L, Giménez F, et al. Cardiac compromise in patients recovered from COVID-19 without troponin elevation assessed by cardiac magnetic resonance imaging. Arch cardiol Mex. 2022.
  23. Asadian S, Farzin M, Tabesh F, Rezaeian N, Bakhshandeh H, Hosseini L, et al. The Auxiliary Role of Cardiac Magnetic Resonance Feature-Tracking Parameters in the Differentiation between Cardiac Amyloidosis and Constrictive Pericarditis. Cardiology Research and Practice. 2021; 2021.
  24. Safaei AM, Kamangar TM, Asadian S, Rezaeian N, Esmati E, Kolahdouzan K, et al. Detection of the early cardiotoxic effects of doxorubicin-containing chemotherapy regimens in patients with breast cancer through novel cardiac magnetic resonance imaging: a short-term follow-up. Journal of Clinical Imaging Science. 2021; 11.
  25. Ulloa JU, de Vega VM, Montañés OS, Vázquez AÁ, Sánchez-Enrique C, Jiménez SH, et al. Cardiac magnetic resonance in recovering COVID-19 patients. Feature tracking and mapping analysis to detect persistent myocardial involvement. IJC Heart & Vasculature. 2021; 36:100854.
  26. Ramadan MS, Bertolino L, Zampino R, Durante-Mangoni E, Iossa D, Ursi MP, et al. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review. Clinical Microbiology and Infection. 2021; 27(9):1250-61.
  27. Del Prete A, Conway F, Della Rocca DG, Biondi-Zoccai G, De Felice F, Musto C, et al. COVID-19, Acute Myocardial Injury, and Infarction. Card Electrophysiol Clin. 2022;14(1):29-39. doi:10.1016/j.ccep.2021.10.004. [PubMed:35221083].