Nearly two years into the COVID-19 pandemic, doctors are still learning new things about the disease that has affected more than 250 million people globally with more than 5 million deaths.
Hanneman
While the disease is primarily a respiratory virus, studies have shown that about one in four patients who require hospitalization for COVID-19 also experience cardiovascular injury, which in turn is associated with a five-to-ten-fold increase in risk of death.
Since many patients do not require hospitalization, there is growing concern for undetected cardiovascular injury in COVID-19 survivors.
The discussion was led by Kate Hanneman, MD, MPH, FRCPC, associate professor in the Department of Medical Imaging at Toronto General Hospital, and also included presentations by Brian Burns Ghoshhajra, MD, associate professor of radiology at Massachusetts General Hospital, Boston and Margarita Revzin, MD, MS, associate professor of radiology and biomedical imaging at Yale School of Medicine, New Haven, CT. Each presenter discussed a number of case studies and showed examples of imaging from actual patients.
Dr. Revzin discussed vascular imaging findings, including pulmonary embolism and arterial vascular findings, and the role of vascular imaging in patients with COVID-19. Dr. Burns Ghoshhajra presented on cardiac imaging findings in patients and athletes who have recovered from COVID-19 and the role of imaging in those populations. Dr. Hanneman spoke about cardiac MRI findings in myocarditis following COVID-19 vaccination as compared to other causes.
Differentiating Vaccine-Associated Myocarditis on Cardiac MRI May Be Challenging
Dr. Hanneman discussed an article she authored that was recently published in Radiology: Cardiothoracic Imaging, "Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 Vaccination."
Myocardial injury and pericarditis following COVID-19. Case example of a 57-year-old woman with COVID-19 who presented with chest pain after elevated troponin levels. Cardiac MRI performed at 1.5T four weeks after PCR-confirmed diagnosis of SARS-CoV-2 infection demonstrates subepicardial late gadolinium enhancement (LGE) at the (A) basal inferior lateral wall with adjacent pericardial enhancement (red arrow), with (B) corresponding high T2-signal (orange arrows), (C) high regional native T1 (1236 msec) and (D) high regional native T2 (67 msec) on short-axis images, in keeping with myopericarditis.
The article found that myocarditis has been reported in a small group of people following administration of mRNA-based COVID-19 vaccines with symptoms that typically appear within a few days of vaccination. The United States Vaccine Adverse Event Reporting System (VAERS) received 1,903 reports of myocarditis among people who received at least one dose of a COVID-19 vaccine as of Aug. 18, 2021, in the context of nearly 360 million total doses administered. The article says that differentiating vaccine-associated myocarditis from other causes of myocardial injury on cardiac MRI may be a challenge as the pattern of findings is similar and there are no longitudinal imaging studies to suggest how long abnormalities persist.
Dr. Hanneman said that as the pandemic continues, research on these topics is still evolving and will continue to advance our understanding of risk factors and long-term outcomes.
"Myocarditis is a very rare adverse event following vaccination and most cases are mild and resolve in the short term, which is encouraging. The risk of cardiac injury related to COVID-19 infection is much higher. Based on the balance of risks and benefits, we should continue to encourage everyone to get vaccinated," she said.
Access the presentation, "Cardiovascular Imaging Manifestations of COVID-19: What the Radiologist Needs to Know," (S1-CVA01) on demand at Meeting.RSNA.org.
