Naslov
Cardiac MRI of adults with multisystem inflammatory syndrome (MIS‑A) after COVID‑19

Autori
Muršić, Miroslav ; Balaško Josipović, Tihana ; Hrabak Paar, Maja

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
International journal of cardiovascular imaging, 37 (2021), 12 / - , 2021, 3639-3639

Skup
European Society of Cardiovascular Radiology annual scientific meeting (ESCR 2021)

Mjesto i datum
Online, 21.10.2021. - 23.10.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
COVID-19 ; MRI ; myocarditis

Sažetak
Purpose/Objectives: Multisystem inflammatory syndrome in adults (MIS-A) is a very rare but severe complication in adults infected with SARS- CoV-2. It’s pathophysiology is similar to a parallel multisystem inflammatory syndrome in children—MIS-C which is widely recognized because of dramatic illness in a previously healthy child that can affect the heart, gastrointestinal tract, skin, or brain— very similar to Kawasaki disease. Although it is difficult to differentiate a severe SARS-CoV-2 case from MIS-A, studies report of a dozen patients who were not on a continuum of severe COVID-19 but developed severe non-pulmonary manifestations without typical viral pneumonia, such as myocarditis. Since MIS-A is a rare but potentially lifethreatening complication of previous SARS-CoV-2 infection with scarce available clinical reports, we present our experience with cardiac MRI in two adult patients. Methods and Materials: Out of a few dozen COVID-19 patients who underwent cardiac MRI at our institution, two male patients (Patient 1 26-year- old, Patient 2 40-years old) showed matching signs and symptoms and were identified as potential MIS- A patients. The examination was performed on a 1.5 T MRI scanner using our institution’s standard protocol for myocarditis that includes steady- state free precession (SSFP) cine imaging, T2- weighted short tau inversion recovery (STIR) imaging, pre-contrast T1 and T2 mapping, post- contrast late gadolinium enhancement (LGE) images after intravenous administration of gadobutrol (0, 15 mmol/kg) and post-contrast T1 mapping in short- and long-axis views. We compared our results with limited results from available published case reports of this rare and new syndrome. To the best of our knowledge, this is the first report of cardiac MRI in MIS-A patients. Results: Both patients were diagnosed with mild COVID- 19 few weeks before admission to the hospital with symptoms of fever, chest pain, fatigue, dyspnea and diarrhea. Laboratory findings revealed elevated inflammatory biomarkers, high- sensitivity troponin I and NT-proBNP. Echocardiography showed dilated left ventricle (LV) with severe reduction of LV ejection fraction (EF). Cardiac MRI in the Patient 1 was performed a week after pulse steroid therapy, intravenous immunoglobulin and heart failure therapy had been started, and showed complete recovery of the LVEF, with slightly increased T1 and T2 relaxation times, and no LGE. In the Patient 2 cardiac MRI was performed 2 days after admission to the intensive care unit, and showed dilated LV with LVEF of 41%, severely prolonged T1 and T2 relaxation times and slight subepicardial LGE. Follow-up MRI performed after 2 weeks of therapy showed normal LV size, function and T1/T2 relaxation times without any LGE. Conclusion: One of life threatening MIS-A manifestations can be post-COVID-19 myocarditis, with rapid improvement of cardiac function after prompt therapy. MRI characteristic findings include prolonged myocardial T1 and T2 relaxation times, myocardial edema, while LGE can be, but is not neccessarily present. Clinicians and radiologists should be familiar with this rare syndrome and MRI is an efficient imaging choice to obtain important information for clinical decision-making.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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