Cardiac magnetic resonance imagining for assessment of the myocardial involvement in COVID-19

The SARS-CoV-2 virus, fi rst identifi ed in December 2019 in the city of Wuhan, has become a huge public health care challenge, with nearly 90 million people infected and more than 1.9 million reported deaths worldwide. Although the main focus of the disease are the respiratory system complications, recently much attention has been drawn to the extrapulmonary manifestation of the virus, which in some cases is decisive for the course of the disease. Increasing evidence suggests that the virus can directly affect the cardiovascular system and lead to complications such as myocarditis, acute coronary syndrome, arrhythmias and venous thromboembolism. The pathogenesis of cardiac damage is currently unclear. Presumed mechanisms include direct viral invasion, cytokine-mediated damage, mismatch between needs and oxygen supply, and ischemic damage resulting from microvascular thrombosis. Cardiac magnetic resonance imaging plays an important role in assessing myocardial changes in patients with COVID-19. The method allows assessment of cardiac morphology and function, as well as characterization of tissue changes in the myocardium. The most commonly observed magnetic resonance changes in patients with COVID-19 are signs of myocarditis with varying degrees of myocardial involvement, and the identifi cation of necrosis and fi brosis is an important predictive sign for the prognosis in these patients. The purpose of this paper is to review the literature and to share our experience with assessment of myocardial damage in COVID-19 with cardiac magnetic resonance imaging