Introduction:

There is evidence that COVID infection can lead to myocarditis. Several studies found typical clinical myocarditis symptoms, elevated Troponin levels and ECG changes. CMR studies describe elevated T1/T2 mapping values and a subepicardial late gadolinium enhancement pattern. Occasionally a pericardial manifestation was found. 

Objective:

To determine the prevalence of COVID induced pericardial effusion and pericarditis.

Methods:

We evaluated patients with clinically suspected myocarditis and a history of a SARS-CoV2-infection who were admitted to the University Heart Center Dresden from January to July in 2021. 49 of them were examined by a 1,5 Tesla MR scanner and analyzed regarding the occurrence of perimyocardial inflammation using 2D and 3D MR sequences.

Results:

49 patients, who were admitted with clinically suspected COVID associated myocarditis, underwent CMR. Two of them were vaccinated against SARS-CoV2 recently, 47 had a clinically apparent COVID-infection in the past.

MR-tomographic signs of myocarditis were obvious in 14 cases, including elevated T1, T2 mapping values, pericarditis/pericardial effusion or the occurrence of a subepicardial late gadolinium enhancement pattern. In 8 out of 14 patients a pericarditis or pericardial effusion was present. 7 patients showed pericarditis or pericardial effusion without signs of myocarditis.

In total 21 patients with suspected COVID-associated affection of the heart were detected. 71% of those showed subepicardial late gadolinium enhancement. Local T1/T2 Mapping values were slightly elevated with 1087 ms +/- 96 ms  and 51 ms +/-7 ms.The average local extracellular volume was elevated with 30 % (normal <27%). The LV-values, as LVEDD, LVEDV or LVEF were in normal ranges.

Summary:

MR-tomographic findings suggest a COVID-associated inflammatory affection of the heart. Past infections may lead to pericardial effusion and inflammation, even without signs of myocarditis.