Cardiac Magnetic Resonance Imaging Findings in COVID-19: Experience from a Tertiary Care Center of North India

Manphool Singhal; Arun Sharma; Shritik Devkota; Harsimran Bhatia; Parag Barwad; Parminder Singh Otaal; Ajay Bahl

doi:10.4103/heartviews.heartviews_123_23

Cardiac Magnetic Resonance Imaging Findings in COVID-19: Experience from a Tertiary Care Center of North India

Heart Views. 2024 Apr-Jun;25(2):69-73. doi: 10.4103/heartviews.heartviews_123_23. Epub 2024 Oct 10.

Authors

Manphool Singhal^#¹, Arun Sharma^#¹, Shritik Devkota¹, Harsimran Bhatia¹, Parag Barwad², Parminder Singh Otaal², Ajay Bahl²

Affiliations

¹ Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
² Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

^# Contributed equally.

PMID: 39619102
PMCID: PMC11604198
DOI: 10.4103/heartviews.heartviews_123_23

Abstract

Purpose: Here, we describe cardiac magnetic resonance imaging (CMR) findings in patients with proven COVID-19 infection and presenting with cardiac problems both at presentation and in convalescence from a tertiary care center, in North India. A pertinent review of the literature is also discussed.

Materials and methods: Retrospective analysis of patients with real-time reverse transcriptase-polymerase chain reaction proven COVID-19 infection either at presentation or convalescence referred for CMR at our facility from January 2021 to December 2023 was done. CMR was performed on a 3T system (Ingenia, Philips Healthcare, Best, The Netherlands) and examinations were customized according to the clinical indications.

Results: Retrospective analysis yielded 14 patients (4 at presentation; 10 in convalescence). Patients at presentation 4/14 had clinically presented with chest pain with raised troponins and electrographic abnormalities, while 10/14 patients had presented with clinical features of heart failure with two-dimensional transthoracic echocardiography demonstrating systolic dysfunction with reduced left ventricular ejection fraction. Out of 14, 4 patients at presentation, CMR showed features of acute myocarditis in three patients, while one had inferior wall myocardial infarction (MI) (this patient on catheter angiogram had aneurysmally dilated coronary arteries with thrombus and stenosis in the mid right coronary artery which was successfully stented). Out of 14, 10 patients on CMR had features of dilated cardiomyopathy (DCMP).

Conclusion: Cardiac involvement in COVID-19 can have vivid clinicoradiological presentations with features of myocarditis and MI at presentation or DCMP in convalescence. CMR in such cases is a problem-solving tool where myocarditis is candidly differentiated from MI. Moreover, follow-up CMR demonstrates temporal changes in COVID-19-associated myocarditis and evaluation of cardiac structure and function in patients presenting with DCMP.

Keywords: Acute coronary syndrome; cardiac magnetic resonance imaging; cardiovascular complications of COVID-19; coronary artery aneurysm; myocardial infarction; myocarditis.