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The role of Cardiac Magnetic Resonance on the diagnosis of COVID-19 related myocarditis
Session:
Posters (Sessão 2 - Écran 5) - Doenças do miocárdio
Speaker:
Rafaela Fernandes
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.7 Myocardial Disease - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rafaela Fernandes; Gonçalo Terleira Batista; Joana Moura Ferreira; Nádia Moreira; Bruno Graça; Vanessa Lopes; Gustavo Campos; Sofia Martinho; Carolina Saleiro; Diana Campos; Ana Rita Gomes; João Rosa; Paulo Donato; Lino Gonçalves; Maria João Ferreira
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background: </strong>Cardiac magnetic resonance (CMR) is the gold standard for non-invasive evaluation of cardiac function, structure and tissue composition. COVID-19 related myocarditis is a rare event but can cause long-term myocardial injury. CMR abnormalities are found in 26-60% of recovered patients. </span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong>Retrospective observational study that included all cases of myocarditis in adult patients, confirmed by CMR, admitted to Cardiology wards in a University Hospital Centre between 2019 and 2022. The purpose was to assert CMR abnormalities and the diagnostic value in COVID-19 patients. The patients were divided into two cohorts according to the year of admission. Thoroughly revision of informatized clinical files was performed and statistical analysis was conducted using SPSS software. </span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong>A total of 48 patients with myocarditis confirmed by CMR were included. Most myocarditis cases (30/62.5%) happened in the second cohort (years 2021 to 2022), which represents an increase of 1.67%. Two (6.7%) were attributed to COVID-19 infection, 2 (6.7%) happened after COVID-19 vaccination and in 1 (2.1%) case the patient had been vaccinated 37 days prior and COVID-19 infection also occurred 28 days prior to the diagnosis. In both cases related to COVID-19 vaccination, the vaccine used messenger ribonucleic acid technology and happened 2 days after inoculation. In all patients there was a non-ischemic (subepicardial or mid myocardial) late T1 gadolinium enhancement. However, in patients with COVID-19 related myocarditis there was a positive correlation with increased extracellular volume (ECV) found in CMR (Pearson’s Qui Square = 23,489, p < 0,001). For patients with myocarditis associated with COVID-19 vaccination, there were no statistically significant findings when comparing CMR findings in T1 and T2. As for structure and cardiac remodulation, neither COVID-19 infection myocarditis or COVID-19 vaccination related myocarditis had statistically significant differences in the exams performed during the acute and late phases of the disease. </span></span></span></p> <p style="text-align:start"><strong><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusion: </span></span></strong><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">Increased ECV in CMR is highly associated with COVID-19 infection myocarditis. This could indicate the high inflammatory process induced, while being absent from COVID-19 vaccine related myocarditis could point to different pathways in which the cardiovascular system is affected. These patients need to be followed for further years to better understand this infection and how it affects the cardiovascular system. </span></span></span></p>
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