Myocardial Injury for COVID-19 Even in Young Patients with Mild Symptoms

Most young COVID-19 patients not requiring hospitalization showed abnormal cardiac magnetic resonance imaging (CMR) beyond two months after diagnosis.

Injuria miocárdica por COVID-19 incluso en jóvenes y con síntomas leves

Myocardial injury had been found in more serious cases, but not in a healthy population recovered at home.

The increasing evidence of the virus’ capacity to directly affect the heart across the whole population and disease severity spectrum turns our previous article published on March 3 obsolete. In only 5 months, we went from denying myocarditis to saying it is frequent, and that it might even be the norm.

78% of patients in a center in Germany showed abnormal CMR findings 2 to 3 months after testing positive for COVID 19 and despite the fact that 67% of these patients never required hospitalization.

Read also: Infarction, Stroke and Aortic Emergency Syndromes in the Shadow of the Pandemic.

Conventional CMR sequences were used to assess cardiac function, volume, myocardial mass and scars in addition to myocardial mapping in T1 and T2.

The study included 100 patients recovering from the infection (mean age 49) who received high-sensitivity troponin T and CMR testing. A few patients in the group presented traditional risk factors, but only one third was hospitalized and only 2 required mechanical ventilation.

In most patients (78%) troponin was detected at CMR time, even though it had been between 64 and 92 days after diagnosis.

Read also: Temporary Emergency Guidelines for Infarction During the Pandemic.

The publication of this study in JAMA Cardiology has raised many questions that remain unanswered. What should we do with these findings and how long will they persist? Is it necessary to take cardio-protection measures of some kind, with anti-inflammatory or cardiac failure medication?

The answers will come from centers that have already fought the first wave while the rest of us weather the storm.

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Original Title: Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19).

Reference: Puntmann VO et al. JAMA Cardiol. 2020; Epub ahead of print.

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