Correlation of acute myocardial injury and long-term cardiac function in COVID-19 survivors with acute myocarditis

Introduction Myocardial injury, indicated by elevated troponin levels, is common among patients hospitalized with COVID-19. This study aimed to evaluate the correlation between the degree of myocardial injury in myocarditis patients and imaging parameters of systolic and diastolic cardiac function and clinical outcome over a 6-month follow-up period. Material and methods A total of 59 COVID-19 myocarditis patients with elevated high-sensitivity troponin levels (hs-cTnI) were included. Demographic data, laboratory results, and clinical outcomes were collected from hospital electronic health records. All patients underwent cardiac magnetic resonance imaging (cMRI) and a comprehensive echocardiographic evaluation at baseline and at the 6-month follow-up. Results COVID-19 myocarditis was confirmed in all patients undergoing cMRI. The mean hs-cTnI level among the patients was 281.27 ±400.86 ng/l. Hs-cTnI elevation showed a significant positive correlation with left ventricular global longitudinal strain (LVGLS) values (p < 0.001, r = 0.6) but not with right ventricular global longitudinal strain (RVGLS) values (p = 0.155, r = 0.187). Reduced LVGLS values were significantly associated with late gadolinium enhancement (LGE) (p < 0.001, r = 0.509) in cMRI and with the administration of antiviral medications, including treatment of remdesivir (p < 0.001, r = 0.62) indicative of more severe disease. Conclusions The increase in hs-cTnI levels in COVID-19 myocarditis patients is associated with future impairment in left ventricular systolic function and deterioration of left ventricular myocardial strain. These findings highlight the importance of monitoring cardiac function in patients with acute myocarditis following COVID-19 infection during long-term follow-up.