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World J Clin Cases. Jul 16, 2022; 10(20): 6784-6793
Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6784
Frontiers of COVID-19-related myocarditis as assessed by cardiovascular magnetic resonance
Yi Luo, Ben-Tian Liu, Wei-Feng Yuan, Can-Xian Zhao
Yi Luo, Department of Radiology, The First People’s Hospital of Longquanyi District, Chengdu 610100, Sichuan Province, China
Ben-Tian Liu, Wei-Feng Yuan, Department of Radiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
Wei-Feng Yuan, Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Can-Xian Zhao, Department of Medical Imaging, Chengdu Second People’s Hospital, Chengdu 610011, Sichuan Province, China
Author contributions: Luo Y performed the majority of the writing, prepared the figure; Liu BT provided the input in writing the paper; Yuan WF and Zhao CX designed the outline and coordinated the writing of the paper.
Supported by Scientific Research Project of Sichuan Provincial Health Commission, No. 20PJ232.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Can-Xin Zhao, Doctor, Teacher, Department of Medical Imaging, Chengdu Second People’s Hospital, The 10th Qingyun South Street, Jinjiang District, Chengdu 610011, Sichuan Province. 1196829145@qq.com
Received: March 23, 2022
Peer-review started: March 23, 2022
First decision: May 12, 2022
Revised: May 16, 2022
Accepted: June 17, 2022
Article in press: June 17, 2022
Published online: July 16, 2022
Abstract

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In some patients, COVID-19 is complicated with myocarditis. Early detection of myocardial injury and timely intervention can significantly improve the clinical outcomes of COVID-19 patients. Although endomyocardial biopsy (EMB) is currently recognized as the ‘gold standard’ for the diagnosis of myocarditis, there are large sampling errors, many complications and a lack of unified diagnostic criteria. In addition, the clinical methods of treating acute and chronic COVID-19-related myocarditis are different. Cardiac magnetic resonance (CMR) can evaluate the morphology of the heart, left and right ventricular functions, myocardial perfusion, capillary leakage and myocardial interstitial fibrosis to provide a noninvasive and radiation-free diagnostic basis for the clinical detection, efficacy and risk assessment, and follow-up observation of COVID-19-related myocarditis. However, for the diagnosis of COVID-19-related myocarditis, the Lake Louise Consensus Criteria may not be fully applicable. COVID-19-related myocarditis is different from myocarditis related to other viral infections in terms of signal intensity and lesion location as assessed by CMR, which is used to visualize myocardial damage, locate lesions and quantify pathological changes based on various sequences. Therefore, the standardized application of CMR to timely and accurately evaluate heart injury in COVID-19-related myocarditis and develop rational treatment strategies could be quite effective in improving the prognosis of patients and preventing potential late-onset effects in convalescent patients with COVID-19.

Keywords: COVID-19, Myocarditis, Cardiovascular magnetic resonance, Inflammation, Diagnosis, Infection

Core tip: This review aims to explore the frontiers of Coronavirus disease 2019 (COVID-19)-related myocarditis as assessed by Cardiac magnetic resonance (CMR) and compare the similarities and differences in CMR signs between COVID-19-related myocarditis and myocarditis related to other viral infections. COVID-19-related myocarditis is different from myocarditis related to other viral infections in SI and lesion location as assessed by CMR. The Lake Louise Consensus Criteria are not fully applicable to COVID-19-related myocarditis. CMR is expected to visualize myocardial damage, locate lesions and quantify pathological changes based on various sequences with the benefit of staged diagnosis and treatment in COVID-19-related myocarditis.