COVID-19: Myocardial Injury in Survivors

Hospitalized COVID-19 patients frequently have myocardial injury with troponin elevation, but underlying etiologies beyond acute coronary syndromes (ACS) and pulmonary emboli (PE) are ill-defined. We used cardiovascular magnetic resonance (CMR) during early convalescence to assess the presence, type and extent of myocardial injury in troponin-positive COVID-19 patients. All patients with COVID-19 discharged from the Royal Free London NHS Foundation Trust until 30th April 2020 were reviewed.

In summary, myocardial injury is common in hospitalized COVID-19 patients and not exclusive to those with ACS or PE. In this single-centre, single-timepoint convalescent study, myocardial injury was associated with cardiac abnormalities detected by CMR where troponin elevation is unexplained even when cardiac function is normal. The main limitation of this study is its cross-sectional design which prompts caution regarding causality of myocardial injury and its relationship to previous COVID-19 infection. Nevertheless, CMR frequently revealed occult coronary artery disease, high rates of myocarditis-like LGE and sometimes dual pathology. The lack of edema in these patients suggests the myocarditis-like scar may be permanent. Further serial study would clarify this and assess the long-term clinical consequences of these findings.