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

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

Automated summary

Recent MRI studies have shown that a significant number of COVID-19 survivors may experience myocardial and pericardial involvement after recovery.