IMR Press / RCM / Volume 23 / Issue 12 / DOI: 10.31083/j.rcm2312389
Open Access Systematic Review
Cardiac Magnetic Resonance Imaging of COVID-19-Associated Cardiac Sequelae: A Systematic Review
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1 Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
2 Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
3 Department of Medicine, Division of Cardiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
*Correspondence: (Tim Q Duong)
Academic Editor: Sophie Mavrogeni
Rev. Cardiovasc. Med. 2022, 23(12), 389;
Submitted: 4 August 2022 | Revised: 16 October 2022 | Accepted: 21 October 2022 | Published: 30 November 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Many COVID-19 survivors experience persistent COVID-19 related cardiac abnormalities weeks to months after recovery from acute SARS-CoV-2 infection. Non-invasive cardiac magnetic resonance (CMR) imaging is an important tool of choice for clinical diagnosis of cardiac dysfunctions. In this systematic review, we analyzed the CMR findings and biomarkers of COVID-19 related cardiac sequela after SARS-CoV-2 infection. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), we conducted a systematic review of studies that assessed COVID-19 related cardiac abnormalities using cardiovascular magnetic resonance imaging. A total of 21 cross-sectional, case-control, and cohort studies were included in the analyses. Results: Ten studies reported CMR results <3 months after SARS-CoV-2 infection and 11 studies >3 months after SARS-CoV-2 infection. Abnormal T1, abnormal T2, elevated extracellular volume, late gadolinium enhancement and myocarditis was reported less frequently in the >3-month studies. Eight studies reported an association between biomarkers and CMR findings. Elevated troponin was associated with CMR pathology in 5/6 studies, C-reactive protein in 3/5 studies, N-terminal pro-brain natriuretic peptide in 1/2 studies, and lactate dehydrogenase and D-dimer in a single study. The rate of myocarditis via CMR was 18% (154/868) across all studies. Most SARS-CoV-2 associated CMR abnormalities resolved over time. Conclusions: There were CMR abnormalities associated with SARS-CoV-2 infection and most abnormalities resolved over time. A panel of cardiac injury and inflammatory biomarkers could be useful in identifying patients who are likely to present with abnormal CMR pathology after COVID-19. Multiple mechanisms are likely responsible for COVID-19 induced cardiac abnormalities.

post-acute COVID-19 symptoms
Graphical Abstract
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Fig. 1.
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