Cardiac injury after 4 months of coronavirus infection disease 2019 in mildly symptomatic patients

Introduction: Cardiovascular involvement during SARS-CoV-2 infection has been described previously in hospitalized patients mainly. The percentage of patients vulnerable after coronavirus infection disease 2019 (COVID-19) is still being under discussion. What remains unknown is the impact of coronary virus on heart on mildly symptomatic patients. Aim of the study The aim of the study was to evaluate cardiac injury 4 months after COVID-19 in mildly symptomatic patients. Material and methods 80 patients successfully cured from COVID-19 were evaluated between 3-4 months after the disease. The study group consisted of 30 males (37.5%) and 50 females (62.5%) with the mean (SD) age 45 (11) years. All patients had laboratory tests, electrocardiogram (ECG) and cardiac magnetic resonance (CMR) done. Cardiac magnetic resonance was performed on 1,5T scanner (Aera, Siemens, Germany). During the CMR study cine imagines, T2-mapping, T1-mapping before and after gadolinium, extracellular volume (ECV) assumption and late gadolinium enhancement were done. Additionally global longitudinal strain was examined. Dedicated software (QMass, Medis, Holland) was used. Results: During SARS-CoV-2 infection 31 patients (39%) had comorbidities, 16 patients (20%) were hospitalized for 3-5 days. 64 (80%) recovered at home, from whom 10 (12.5%) were asymptomatic. At the time of CMR, high-sensitivity troponin I (hs TnI) was in the normal range in all subjects, while 8 (10%) subjects showed slightly elevated NT pro-BNP and 11 (14%) subjects showed elevated D-dimers. Based on myocardial injury detected during CMR the patients were divided into 2 groups. CMR examination showed myocardial injury in 34 (42.5%) patients. The patients with myocardial injury had significant higher native T1 (1011ms in injured group vs 967ms in group without injury;p = 0.006) and ECV (29.5% vs 27% respectively;p = 0.003). NT pro-BNP levels were elevated in 9 patients with myocardial injury on CMR. None of the patients without myocardial injury had NT pro-BNP elevated (p = 0.007). Conclusions: This study indicates that even in mildly symptomatic patients there are occurrences of myocardial injury. The cardiac magnetic resonance is a useful tool for diagnosing myocardial injury after COVID-19.