Table 1.

Studies of imaging findings (TTE/CMR) in patients with COVID-19

Authors	Study Design	Imaging Modality	Population	Results
Giustino et al,35 2020	International, multicenter retrospective study Cardiac Injury Research in COVID-19 Registry (CRIC-19)	TTE	N = 305 hospitalized patients with COVID-19 Age, range (y): 63 (53–73) Male/Female, n: 205/305	Myocardial injury was observed in 190 patients (62.3%) TTE abnormal in 2/3rds of patients with myocardial injury: • LV wall motion abnormalities (N = 45, 23.7%) • LV global dysfunction (N = 35, 18.4%) • RV dysfunction (N = 50, 26.3%) • Pericardial effusion (N = 22, 7.2%) • Diastolic dysfunction grade II or III (N = 25, 13.2%) In-hospital mortality: • 5.2% in patients without myocardial injury • 18.6% in patients with myocardial injury and without TTE abnormalities • 31.7% in patients with myocardial injury and TTE abnormalities
Dweck et al,36 2020	Prospective international survey (www.escardio.org/eacvi/surveys)	TTE	N = 1216 hospitalized patients with COVID-19, 69 countries Age, range (y): 62 (52–71) Male/Female, n: 844/365	667 (55%) patients had abnormal TTE: • 39% LV abnormalities (predominantly not specific) • 33% RV abnormalities (more common in patients with more severe COVID-19) • 14% severe LV, RV, or biventricular systolic dysfunction Independent predictors of LV abnormalities: elevated NPs (OR 2.96; 95% CI, 1.75–5.05) and troponin (OR 1.69; 95% CI, 1.13–2.53) Independent predictor of RV abnormalities: severity of COVID-19 symptoms (OR 3.19; 95% CI, 1.73–6.10)
Szekely et al,37 2020	Prospective observational single-center study	TTE	N = 100 hospitalized patients with COVID-19 Age, mean ± SD (y): 66.1 ± 17.3 Male/Female, n: 63/37	68 (68%) patients had abnormal TTE: • 39% RV dilatation ± dysfunction • 16% LV diastolic dysfunction • 10% LV systolic dysfunction • 3% valvular heart disease 60% among deteriorating patients had RV dilatation and dysfunction (+/-DVT)
Kim et al,43 2020	Prospective Multicenter Registry	TTE	N = 510 hospitalized patients with COVID-19 Age, mean ± SD (y): 64 ± 14 Male/Female, n: 335/175	•35% RV dilatation •15% RV dysfunction •RV dysfunction increased stepwise with RV dilatation •Adverse RV remodeling predicted mortality independent of clinical and biomarker risk stratification (HR 2.73; 95% CI, 1.72–4.35; P < .001)
Li et al,44 2020	Prospective observational single-center study	TTE	N = 120 hospitalized patients with COVID-19 Age, mean ± SD (y): 61 ± 14 Male/Female, n: 57/63 N = 37 healthy volunteers	RVLS was a powerful predictor of higher mortality in patients with COVID-19 (HR 1.33; 95% CI, 1.15–1.53; P < .001) The best cut-off value of RVLS for prediction of outcome was −23% (AUC: 0.87; P < .001; sensitivity, 94.4%; specificity, 64.7%).
Goerlich et al,53 2020	Retrospective observational single-center study	TTE	N = 75 hospitalized patients with COVID-19 Cases (n = 39): basal LS <13.9% (absolute value) Controls (n = 36): basal LS >13.9% (absolute value) Age, mean ± SD (y): 61.9 ± 13.5 Male/Female, n: 44/31	52% had a reduced basal strain on STE (basal LS 10.0 ± 2.9% vs 16.9 ± 2.3%, P < .001) GLS was significantly lower in COVID-19 cases vs controls (13.9 ± 4.1% vs 18.8 ± 2.7%, P < .001) LVEF (%) was similar between groups (62.5 [55.0–64.4] vs 57.5 [47.5–62.5], P = .11
Puntmann et al,63 2020	Prospective observational single-center study	CMR	N = 100 patients recovered from COVID-19, CMR 71 (64–92) days from positive test Age, mean ± SD (y): 49 ± 14 Male/Female:53/47 N = 50 age and sex matched healthy controls N = 57 risk factor matched controls	Patients recovered from COVID-19 had lower LVEF and RVEF, higher LVEDVi, and raised native T1 and T2 values compared with both control groups. Greater proportions of patients with ischemic (32% vs 17%) and nonischemic (20% vs 7%) LGE patterns than the risk factor matched control group. There was a greater proportion of cases with pericardial enhancement (22% vs 14%) and pericardial effusion (20% vs 7%) compared with the risk factor matched control group.
Huang et al,64 2020	Retrospective observational single-center study	CMR	N = 26 patients recovered from moderate-severe COVID-19 Age, range (y): 38 (32–45) Male/Female: 10/16 N = 20 age and sex matched healthy controls	58% had abnormal CMR: • Myocardial edema in 14 patients (54%) • LGE in 8 patients (31%) Global native T1, T2, and ECV values were significantly elevated in recovered COVID-19 patients with positive conventional CMR findings, compared with patients without positive findings and healthy controls Decreased RV function parameters (RVEF, RVCO, RVCI, and RVSV) were found in patients with positive conventional CMR findings, compared with healthy controls (P < .05)
Kotecha et al,65 2021	Prospective observational multicentre study	CMR	N = 148 recovered COVID-19 patients (moderate-severe COVID-19) Age mean ± SD (y): 64 ± 12 Male/Female: 104/44 N = 40 risk factor matched controls N = 40 healthy volunteers	•LV function was normal in 89% •Myocarditis-like scar noted in 26% •Infarction and/or ischemia in 22% •Dual pathology in 6% No difference in LVEDVi, LVESVi, LVEF between recovered COVID-19 patients and risk factor matched controls. No difference in native T1, T2 values between recovered COVID-19 patients and risk factor matched controls. Higher proportion of subepicardial LGE noted in recovered COVID-19 patients compared with risk factor matched controls (22% vs 5%, P = .018). Higher levels of RVEDVi, RVESVi, RVEF noted in recovered COVID-19 patients compared with risk factor matched controls
Rajpal et al,66 2021	Case Series (single centre)	TTE, CMR	N = 26 competitive college athletes recovered from COVID-19 (14 asymptomatic, 12 mild symptoms) Age, mean ± SD (y): 19.5 ± 1.5 Male/Female: 15/11	Normal biventricular size and function by TTE and CMR None had troponin elevation or diagnostic ST/T wave changes on ECG 4 athletes (15%) met the updated LLC for clinically suspected myocarditis 8 athletes (30%) had nonspecific LGE
Starekova et al,67 2021	Case Series (single centre)	TTE, CMR	N = 145 competitive college athletes recovered from COVID-19 (17% asymptomatic, 49% mild, 28% moderate symptoms) Age, range (y): 20 (17–23) Male/Female: 108/37	TTE was unremarkable 2 athletes (1.4%) had myocarditis by LLC, troponin abnormal in the more severe case 40 patients (27.6%) had small nonspecific foci of LGE
Gorecka et al,70 2021 COVID-HEART Investigators	Prospective observational multicentre study (COVID-HEART study)	CMR	Inclusion criteria: hospitalized patient population (age ≥ 18 y), or those recently discharged from hospital (within 28 d after discharge), with a diagnosis of COVID-19 Exclusion criteria: unable or unwilling to consent, contraindication to CMR, pregnancy or breast-feeding Risk factor matched controls: matched on age and CVD risk factors cohort	Ongoing trial

AUC, area under the receiver operating characteristic curve; CI, confidence interval; CMR, cardiac magnetic resonance; COVID-19, coronavirus disease 2019; DVT, deep vein thrombosis; ECG, electrocardiogram; ECV, extracellular volume fraction; GLS, global longitudinal strain; HR, hazard ratio; LGE, late gadolinium enhancement; LLC, Lake Louise criteria; LS, longitudinal strain; LV, left ventricular; LVEDVi, left ventricular end-diastolic volume index; LVEF, left ventricular ejection fraction; LVESVi, left ventricular end-systolic volume index; NPs, natriuretic peptides; OR, odds ratio; RV, right ventricular; RVCI, right ventricular cardiac index; RVCO, right ventricular cardiac output; RVEDVi, right ventricular end-diastolic volume index; RVEF, right ventricular ejection fraction; RVESVi, right ventricular end-systolic volume index; RVLS, right ventricular longitudinal strain; RVSV, right ventricular stroke volume; SD, standard deviation; STE, speckle tracking echocardiography; TTE, transthoracic echocardiogram.