TORONTO – A small proportion of patients will show myocardial inflammation on PET soon after recovery from COVID-19. This is associated with cardiac changes in the MRI and increased levels of inflammation in the blood, but resolves relatively quickly in the follow-up. This shows an in JAMA Cardiology published study (DOI: 10.1001/jamacardio.2021.5505)
The prospective cohort study enrolled 47 recovered patients approximately 3 months previously diagnosed with COVID-19. The authors of the study, led by Kate Hanneman from the Department of Medical Imaging at the Toronto General Hospital, used a fluorodeoxyglucose (FDG)-PET to examine whether the study participants exhibited changes in myocardial metabolism. They analyzed the heart function and any changes in the heart tissue using MRI. They also tested the blood of those who had recovered for inflammatory markers.
The average time between COVID-19 diagnosis and PET/MRI was 67 days. Most patients (85%) had recovered from the infection at home.
Small fraction showed focal FDG uptake
In 8 subjects (17%), focal FDG uptake on PET was consistent with myocardial inflammation. Recoveries with and without focal FDG uptake showed characteristic differences.
Hanemann and her colleagues report increases in regional T1 and T2 as well as in extracellular volume in those who have recovered with focal FDG uptake. They also had a higher prevalence of late gadolinium enhancement (75% vs. 23%), lower left ventricular ejection fraction (55 vs. 62%), and poorer longitudinal and circumferential strain (-16 vs. -17% and -18 vs. -20%) on.
Systemic inflammatory blood markers such as interleukin-6 and 8 and highly reactive C-reactive protein were higher in them than in those recovered without focal FDG uptake.
Changes normalized relatively quickly
Repeat examinations an average of 52 days after the baseline PET/MRI showed that the PET/MRI findings and the inflammatory values in the blood had normalized or at least improved.
The authors working with Hanemann therefore conclude that “in a minority of COVID-19 patients, post-disease inflammation of the myocardium occurs, which is associated with systemic inflammation and resolves after a short time”. © nec / aerzteblatt.de