Cardiac magnetic resonance findings in acute and post‐acute COVID‐19 patients with suspected myocarditis

INTRODUCTION: Cardiac injury is commonly reported in COVID‐19 patients, resulting associated to pre‐existing cardiovascular disease, disease severity, and unfavorable outcome. Aim is to report cardiac magnetic resonance (CMR) findings in patients with myocarditis‐like syndrome during the acute phase of SARS‐CoV‐2 infection (AMCovS) and post‐acute phase (cPACS). METHODS: Between September 2020 and January 2022, 39 consecutive patients (24 males, 58%) were referred to our department to perform a CMR for the suspicion of myocarditis related to AMCovS (n = 17) and cPACS (n = 22) at multimodality evaluation (clinical, laboratory, ECG, and echocardiography). CMR was performed for the assessment of volume, function, edema and fibrosis with standard sequences and mapping techniques. CMR diagnosis and the extension and amount of CMR alterations were recorded. RESULTS: Patients with suspected myocarditis in acute and post‐COVID settings were mainly men (10 (59%) and 12 (54.5%), respectively) with older age in AMCovS (58 [48–64]) compared to cPACS (38 [26–53]). Myocarditis was confirmed by CMR in most of cases: 53% of AMCovS and 50% of cPACS with negligible LGE burden (3 [IQR, 1–5] % and 2 [IQR, 1–4] %, respectively). Myocardial infarction was identified in 4/17 (24%) patients with AMCovS. Cardiomyopathies were identified in 12% (3/17) and 27% (6/22) of patients with AMCovS and cPACS, including DCM, HCM and mitral valve prolapse. CONCLUSIONS: In patients with acute and post‐acute COVID‐19 related suspected myocarditis, CMR improves diagnostic accuracy characterizing ischemic and non‐ischemic injury and unraveling subclinical cardiomyopathies.