Cardiac Magnetic Resonance Imaging Findings in 2954 COVID-19 Adult Survivors: A Comprehensive Systematic Review

Abstract

Background: Recent studies have utilized MRI to determine the extent to which COVID-19 survivors may experience cardiac sequels after recovery.

Purpose: To systematically review the main cardiac MRI findings in COVID-19 adult survivors.

Study type: Systematic review.

Subjects: A total of 2954 COVID-19 adult survivors from 16 studies.

Field strength/sequence: Late gadolinium enhancement (LGE), parametric mapping (T1-native, T2, T1-post (extracellular volume fraction [ECV]), T2-weighted sequences (myocardium/pericardium), at 1.5 T and 3 T.

Assessment: A systematic search was performed on PubMed, Embase, and Google scholar databases using Boolean operators and the relevant key terms covering COVID-19, cardiac injury, CMR, and follow-up. MRI data, including (if available) T1, T2, extra cellular volume, presence of myocardial or pericardial late gadolinium enhancement (LGE) and left and right ventricular ejection fraction were extracted.

Statistical tests: The main results of the included studies are summarized. No additional statistical analysis was performed.

Results: Of 1601 articles retrieved from the initial search, 12 cohorts and 10 case series met our eligibility criteria. The rate of raised T1 in COVID-19 adult survivors varied across studies from 0% to 73%. Raised T2 was detected in none of patients in 4 out of 15 studies, and in the remaining studies, its rate ranged from 2% to 60%. In most studies, LGE (myocardial or pericardial) was observed in COVID-19 survivors, the rate ranging from 4% to 100%. Myocardial LGE mainly had nonischemic patterns. None of the cohort studies observed myocardial LGE in "healthy" controls. Most studies found that patients who recovered from COVID-19 had a significantly greater T1 and T2 compared to participants in the corresponding control group.

Data conclusion: Findings of MRI studies suggest the presence of myocardial and pericardial involvement in a notable number of patients recovered from COVID-19.

Level of evidence: 3 TECHNICAL EFFICACY STAGE: 3.

Keywords: COVID-19; adult survivors; cardiac magnetic resonance imaging.