Cardiovascular Magnetic Resonance for Patients With COVID-19

Petersen, Steffen E.; Friedrich, Matthias G.; Leiner, Tim; Elias, Matthew D.; Ferreira, Vanessa M.; Fenski, Maximilian; Flamm, Scott D.; Fogel, Mark; Garg, Ria; Halushka, Marc K.; Hays, Allison G.; Kawel-Boehm, Nadine; Kramer, Christopher M.; Nagel, Eike; Ntusi, Ntobeko A.B.; Ostenfeld, Ellen; Pennell, Dudley J.; Raisi-Estabragh, Zahra; Reeder, Scott B.; Rochitte, Carlos E.; Starekova, Jitka; Suchá, Dominika; Tao, Qian; Schulz-Menger, Jeanette; Bluemke, David A.

COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19–related myocarditis is likely infrequent, COVID-19–related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post–COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19–related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.