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. 2020 May 11;jeaa136.
doi: 10.1093/ehjci/jeaa136. Online ahead of print.

The Role of Cardiovascular Imaging for Myocardial Injury in Hospitalized COVID-19 Patients

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Free PMC article

The Role of Cardiovascular Imaging for Myocardial Injury in Hospitalized COVID-19 Patients

Bernard Cosyns et al. Eur Heart J Cardiovasc Imaging. .
Free PMC article

Abstract

Recent EACVI recommendations described the importance of limiting cardiovascular imaging during the COVID-19 pandemic in order to reduce virus transmission, protect healthcare professionals from contamination, and reduce consumption of personal protective equipment. However, an elevated troponin remains a frequent request for cardiac imaging in COVID-19 patients, partly because it signifies cardiac injury due to a variety of causes and partly because it is known to convey a worse prognosis. The present paper aims to provide guidance to clinicians regarding the appropriateness of cardiac imaging in the context of troponin elevation and myocardial injury, how best to decipher the mechanism of myocardial injury, and how to guide patient management.

Keywords: COVID-19; Cardiac magnetic resonance; Computed tomography; Echocardiography; Lung ultrasound; Myocardial injury; Troponin.

Figures

Figure 1
Figure 1
Indications for cardiac imaging in COVID-19 patients with myocardial injury. CAD = coronary artery disease; VES = ventricular extrasystoles; HF = heart failure; VHD = valvular heart disease; LE = lung embolism; ICU = intensive care unit; SOE = source of embolism.
Figure 2
Figure 2
Additional possible mechanisms to classical coronary syndromes in COVID-19 with myocardial injury.
Figure 3
Figure 3
Stepwise approach in COVID-19 with myocardial injury and suspicion of CAD. QOL = quality of life; Tx = treatment; PTP = pre-test probability; CVD = cardiovascular disease; CVRF = cardiovascular risk factors; CCTA = cardiac computed tomography angiography. Adapted from Knuuti et al.

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