To compare myocardial injury in COVID 19 patients presented with myocardial infarction and non COVID Patients presented with myocardial infarction evaluated with CMR
Coronavirus disease 2019 (COVID-19) is a global pandemic affecting 185 countries and >3 000 000 patients worldwide as of April 28, 2020. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2,. Among patients with COVID-19, there is a high prevalence of cardiovascular disease, and >7% of patients experience myocardial injury from the infection (22% of critically ill patients). Although angiotensin-converting enzyme 2 serves as the portal for infection, the role of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers requires further investigation. However, much like any other respiratory tract infection, pre-existing cardiovascular disease (CVD) and CV risk factors enhance vulnerability to COVID-19. Further, COVID-19 can worsen underly- ing CVD and even precipitate de novo cardiac complications. Preliminary reports suggest that haemostatic abnormalities, including disseminated intravascular coagulation (DIC), occur in patients affected by COVID-19. Additionally, the severe inflammatory response, critical illness, and underlying traditional risk factors may all predispose to thrombotic events, similar to prior virulent zoonotic coronavirus outbreaks CMR is the reference non-invasive standard for cardiac function and tissue characterization and may offer an effective and efficient diagnostic imaging choice to obtain critical information for clinical decision-making.
Radiation: cardiac magnetic resonance
o CMR protocol:
Cine imaging to assess regional & global ventricular function according to the AHA 16-segment model.
T2-weighted imaging to detect extent & distribution of myocardial edema.
Early Gd enhancement imaging to detect extent & distribution of myocardial hyperemia.
Late Gd enhancement imaging to detect extent & distribution of myocardial necrosis.
Single-short sequences & other acceleration techniques will be used as appropriate in patients with poor ability to hold their breath.
Post-processing analysis will be done on a dedicated workstation
Inclusion Criteria: 1. Patients presenting with symptoms and ECG indicative of acute MI (both STEMI & NSTEMI) AND confirmed COVID-19. 2. Patients admitted with acute MI (both STEMI & NSTEMI) who develop COVID-19 symptoms during hospital admission & are confirmed by RT-PCR to have COVID-19
Exclusion Criteria: 1. History of previous diagnosis of STEMI or myocarditis. 2. History of previous PCI in infarcted related artery or NSTEMI 3. Severe respiratory distress that precludes lying supine in the CMR scanner. 4. Acute kidney injury with rapidly declining GFR or GFR that is persistently below 30 ml/min/1.73 m2 (contraindication for Gadopentetate dimeglumine contrast).