The diagnostic utility of cardiac imaging (echocardiogram and cardiac magnetic resonance) in covid 19 patients and cardiac complications: retrospective cohort study in Saudi Arabia

Objectives: Coronavirus disease (COVID-19) continues to cause considerable morbidity and mortality worldwide. The complication in patients with severe COVID-19 disease include arrhythmias, peri-myocarditis (PM), and heart failure (HF). The important role of echocardiogram (ECHO) and cardiac MRI (CMRI) in the diagnosis of myocarditis in COVID-19 patients in Saudi Arabia has not been assessed. The objective is to assess the diagnostic value of ECHO and CMRI and define phenotypes patterns in the COVID 19 subgroup. Methods: In this retrospective study, adults with suspected COVID-19 presented with dyspnea and cardiovascular comorbidities were studied between January 2021 and December 2021. We collected 329 patients, (LVEF by ECHO was 44±11%). Fifty-two percent (173/329), had HF (HFrEF or HFpEF), thirty-six percent presented with acute coronary syndrome ACS (120/329), and four percent had adult congenital heart disease (ACHD). CMRI was performed in 160 patients (LVEF is 40±11%), and fifty-two were COVID-19 positive. Based on the Lake Louis criteria, CMRI was performed at siemens 3 T can identify myocardial function and damage using Late Gadolinium Enhancement (LGE) images phenotypes pattern were described as normal, ischemic, or nonischemic (peri-myocarditis). LVEF was divided by CMRI as (EF≥50 or EF<50%). Comparison of Cardiac MRI LGE in the COVID 19 subgroups according to the LVEF was analyzed. The average time interval from diagnosis to CMRI was 4-8weeks. Results: Sixty percent of patients (221/329) were confirmed COVID-19 infection, the mean age is 54±13 years. Ten patients were diagnosed with pulmonary embolism (2/10 were ACHD). Peri-myocarditis patterns were found in sixty percent of COVID-19 patients (31/52), five percent (3/52) had an ischemic pattern, and thirty- five percent (18/52) had normal LGE (X2 =21.8 and P value<0.001). However, in COVID-19 negative patients, Eighty percent (85/108) had an ischemic pattern, and twenty percent (23/108) had normal LGE. (X2 =37.7 and P value<0.001). Conclusion: In this observational study, CMRI confirms its high diagnostic tool in evaluating myocarditis activity. In COVID-19 patients, two third of the population were found to have peri-myocarditis, with half of them reporting LVEF was ≥50 %. (X2 =67.1 and P value<0.001).