Cardiac Magnetic Resonance Findings in Patients Recovered from COVID-19 Pneumonia and Presenting with Persistent Cardiac Symptoms: The TRICITY-CMR Trial

SIMPLE SUMMARY: The high prevalence of persistent cardiovascular symptoms in patients after coronavirus disease 2019 (COVID-19) recovery emphasizes the need for the investigation of cardiac complications. We present the results of the TRICITY-CMR study designed as a single-center, cross-sectional study. Our major goal was to estimate the prevalence of non-ischemic cardiac injury (defined as active myocarditis and/or late gadolinium enhancement (LGE)) on cardiac magnetic resonance (CMR). Additional purposes were to compare clinical characteristic and CMR findings between patients hospitalized and non-hospitalized during the acute phase of COVID-19 pneumonia. Our results indicate that at least half of patients with persistent cardiovascular symptoms present with non-ischemic cardiac injury in CMR, mainly manifested as LGE lesions. The majority of LGE lesions were located in the left ventricle at inferior and inferolateral segments at the base. Active myocarditis was found in the minority of individuals. Moreover, the need for hospitalization during the acute phase of COVID-19 was not associated with a greater risk of non-ischemic cardiac injury. Further studies are required to determine the long-term cardiovascular consequences of COVID-19. ABSTRACT: The prevalence and clinical consequences of coronavirus disease 2019 (COVID-19)-related non-ischemic cardiac injury are under investigation. The main purpose of this study was to determine the occurrence of non-ischemic cardiac injury using cardiac magnetic resonance (CMR) imaging in patients with persistent cardiac symptoms following recovery from COVID-19 pneumonia. We conducted a single-center, cross-sectional study. Between January 2021 and May 2021, we enrolled 121 patients with a recent COVID-19 infection and persistent cardiac symptoms. Study participants were divided into those who required hospitalization during the acute phase of SARS-CoV-2 infection (n = 58; 47.9%) and those non-hospitalized (n = 63; 52.1%). Non-ischemic cardiac injury (defined as the presence of late gadolinium enhancement (LGE) lesion and/or active myocarditis in CMR) was detected in over half of post-COVID-19 patients (n = 64; 52.9%). LGE lesions were present in 63 (52.1%) and active myocarditis in 10 (8.3%) post-COVID-19 study participants. The majority of LGE lesions were located in the left ventricle at inferior and inferolateral segments at the base. There were no significant differences in the occurrence of LGE lesions (35 (60.3%) vs. 28 (44.4%); p = 0.117) or active myocarditis (6 (10.3%) vs. 4 (6.3%); p = 0.517) between hospitalized and non-hospitalized post-COVID-19 patients. However, CMR imaging revealed lower right ventricular ejection fraction (RVEF; 49.5 (44; 54) vs. 53 (50; 58) %; p = 0.001) and more frequent presence of reduced RVEF (60.3% vs. 33.3%; p = 0.005) in the former subgroup. In conclusion, more than half of our patients presenting with cardiac symptoms after a recent recovery from COVID-19 pneumonia had CMR imaging abnormalities indicating non-ischemic cardiac injury. The most common finding was LGE, while active myocarditis was detected in the minority of patients. CMR imaging abnormalities were observed both in previously hospitalized and non-hospitalized post-COVID-19 patients. Further research is needed to determine the long-term cardiovascular consequences of COVID-19 infection and the optimal management of patients with suspected post-COVID-19 non-ischemic cardiac injury.