Low Prevalence of Late Myocardial Injury on Cardiac MRI Following COVID-19 Infection

J Magn Reson Imaging. 2023 Dec;58(6):1777-1784. doi: 10.1002/jmri.28668. Epub 2023 Mar 5.


Background: The prevalence of abnormal cardiac magnetic resonance imaging (MRI) findings indicative of myocardial injury in patients who recovered from coronavirus disease 2019 (COVID-19) is currently unclear, with a high variability in the reported prevalence.

Purpose: To assess the prevalence of myocardial injury after a COVID-19 infection.

Study type: Prospective, bicentric study.

Subjects: Seventy consecutive patients who recovered from COVID-19 and were previously hospitalized. Mean age was 57 years and 39% of the patients were female. Ten healthy controls and a comparator group of 75 nonischemic cardiomyopathy (NICM) patients were employed.

Field strength/sequence: 1.5-T, steady-state free precession (SSFP) gradient-echo sequence, modified Look-Locker inversion recovery sequence with balanced SSFP readout, T2-prepared spiral readout sequence and a T1-weighted inversion recovery fast gradient-echo sequence was acquired ~4-5 months after recovery from COVID-19.

Assessment: The SSFP sequence was utilized for the calculation of left and right ventricular volumes and ejection fractions (LVEF and RVEF) following manual endocardial contouring. T1 and T2 mapping was performed by pixel-wise exponential fitting, and T1 and T2 values were computed by manual contouring of the left ventricular endocardial and epicardial walls. Late gadolinium enhancement (LGE) images were graded qualitatively as LGE present or absent.

Statistical tests: T-tests and the χ2 or Fisher's exact tests were used to compare continuous and categorical variables respectively between the COVID-19 and NICM groups. Inter-rater agreement was evaluated by the intraclass correlation coefficient for continuous variables and Cohen's kappa test for LGE.

Results: Reduced RVEF occurred in 10%, LGE and elevated native T1 in 9%, reduced LVEF in 4%, and elevated T2 in 3% of COVID-19 patients, respectively. Patients with NICM had lower mean LVEF (41.6% ± 6% vs. 60% ± 7%), RVEF (46% ± 5% vs. 61% ± 9%), and a significantly higher prevalence of LGE (27% vs. 9%) when compared to those post-COVID-19.

Data conclusion: Abnormal cardiac MRI findings may show a low prevalence in patients who recovered from COVID-19 and were previously hospitalized.

Level of evidence: 2 TECHNICAL EFFICACY: Stage 2.

Keywords: COVID-19; cardiac; myocardial injury; myocarditis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19*
  • Cardiomyopathies* / diagnostic imaging
  • Cardiomyopathies* / epidemiology
  • Contrast Media
  • Female
  • Gadolinium
  • Heart Injuries*
  • Humans
  • Magnetic Resonance Imaging
  • Magnetic Resonance Imaging, Cine
  • Male
  • Middle Aged
  • Myocardium
  • Predictive Value of Tests
  • Prevalence
  • Prospective Studies
  • Stroke Volume


  • Contrast Media
  • Gadolinium