Cardiac Magnetic Resonance Relaxometry Parameters, Late Gadolinium Enhancement, and Feature-Tracking Myocardial Longitudinal Strain in Patients Recovered from COVID-19

Jadwiga Fijalkowska; Anna Glinska; Marcin Fijalkowski; Katarzyna Sienkiewicz; Dorota Kulawiak-Galaska; Edyta Szurowska; Joanna Pienkowska; Karolina Dorniak

doi:10.3390/jcdd10070278

Cardiac Magnetic Resonance Relaxometry Parameters, Late Gadolinium Enhancement, and Feature-Tracking Myocardial Longitudinal Strain in Patients Recovered from COVID-19

J Cardiovasc Dev Dis. 2023 Jun 29;10(7):278. doi: 10.3390/jcdd10070278.

Authors

Jadwiga Fijalkowska¹, Anna Glinska¹, Marcin Fijalkowski², Katarzyna Sienkiewicz¹, Dorota Kulawiak-Galaska³, Edyta Szurowska¹, Joanna Pienkowska¹, Karolina Dorniak⁴

Affiliations

¹ Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland.
² First Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland.
³ Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland.
⁴ Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, 80-211 Gdansk, Poland.

Abstract

COVID-19 infection is associated with myocarditis, and cardiovascular magnetic resonance (CMR) is the reference non-invasive imaging modality for myocardial tissue characterization. Quantitative CMR techniques, such as feature tracking (FT) and left ventricular global longitudinal strain (GLS) analysis, have been introduced as promising diagnostic tools to improve the diagnostic accuracy of suspected myocarditis. The aim of this study was to analyze the left ventricular global longitudinal strain (GLS) and the influence of T1 and T2 relaxation times, ECV, and LGE appearance on GLS parameters in a multiparametric imaging protocol in patients who recovered from COVID-19. The 86 consecutive patients enrolled in the study had all recovered from mild or moderate COVID-19 infections; none required hospitalization. Their persistent symptoms and suspected myocarditis led to cardiac magnetic resonance imaging within 3 months of the diagnosis of the SARS-CoV-2 infection. Results: Patients with GLS less negative than -15% had significantly lower LVEF (53.6% ± 8.9 vs. 61.6% ± 4.8; <0.001) and were significantly more likely to have prolonged T1 (28.6% vs. 7.5%; p = 0.019). Left ventricular GLS correlated significantly with T1 (r = 0.303; p = 0.006) and LVEF (r = -0.732; p < 0.001). Left ventricular GLS less negative than -15% was 7.5 times more likely in patients with prolonged T1 (HR 7.62; 95% CI 1.25-46.64). The reduced basal inferolateral longitudinal strain had a significant impact on the global left ventricular longitudinal strain. ROC results suggested that a GLS of 14.5% predicted prolonged T1 relaxation time with the best sensitivity and specificity. Conclusions: CMR abnormalities, including a myocarditis pattern, are common in patients who have recovered from COVID-19. The CMR feature-tracking left ventricular GLS is related to T1 relaxation time and may serve as a novel parameter to detect global and regional myocardial injury and dysfunction in patients with suspected myocardial involvement after recovery from COVID-19.

Keywords: cardiac magnetic resonance imaging; coronavirus disease; late gadolinium enhancement; myocardial longitudinal strain; myocarditis; non-ischemic cardiac injury.

Grants and funding

This research was funded by Medical University of Gdansk’s Grant Program “Young Creator of Science” number 71-1101-MPK 664—part of the “Excellence Initiative Research University” Program.