Prognostic role of advanced cardiac imaging in assessing myocardial injury and its correlation with biomarkers in young patients recovering from COVID 19

Introduction The acute effects of COVID-19 on the cardiovascular system have been widely studied [1]. The long-term impact of COVID-19 on young people without previous cardiovascular disease (CVD) remains an important area of investigation [2]. Advanced imaging techniques and inflammatory biomarkers, provide valuable insights into the long-term effects of COVID-19 in young adults without a history of CVD [3]. Objective This study examines late-stage myocardial injury in young adults without prior CVD who present with cardiac symptoms after COVID-19. Materials and Methods Three groups of young individuals (ages 18-44) were formed: the main group (89 patients with COVID-19, no prior CVD, but with CVD risk factors); the 1st control group (59 individuals without COVID-19, no CVD, but with CVD risk factors); the 2nd control group (29 healthy volunteers). Risk factors included smoking, family history, prediabetes, diabetes, hyperlipidemia (LDL ≥ 120 mg/dL), obesity (BMI > 25 kg/m²). The main group was studied 2-6 months after recovering from COVID-19. Cardiac MRI was performed twice (initially and at 12 months). CMR mapping techniques were used to detect interstitial edema and fibrosis. At the study's start, high-sensitivity C-reactive protein (Hs-CRP) and Matrix Metalloproteinase-9 (MMP-9) were measured. Control groups underwent cardiac MRI and biomarker assessments at the initial period. Results In the main group, 30 patients (33.7%) showed myocardial damage in the form of interstitial edema (IE) and interstitial fibrosis (IF). While IF was present in all 30 (100%), both IE and IF were observed in 14 (46.7%), subepicardial LGE was found in 18 patients (20.02%). After one year, a follow-up cardiac MRI was performed only on these 30 patients. In 18 patients with myocardial damage, subepicardial replacement fibrosis persisted. In all 18, T2 mapping values normalized. Among them, 6 (33.3%) had elevated T1 values and reduced LV contractility (LVEF ≤ 57%), while 12 (66.6%) had normal T1 values and LVEF > 57%. In the other 12 patients of the 30 (40%), both T1 and T2 values returned to normal, restoring myocardial function. No myocardial damage was observed in the control groups. A correlation was found between biomarkers and CMR. In patients with unrecognized myocarditis, Hs-CRP was elevated, particularly in those with IE. MMP-9 was elevated in patients with replacement fibrosis (RF) on CMR. Inflammation associated with IE was confirmed by the rise in Hs-CRP, while fibrosis was marked by increased proliferative processes and elevated MMP-9 levels. Conclusion Within 2-6 months after COVID-19 infection, residual myocardial inflammation was found in one-third of young patients with CVD risk factors but without previous CVD. Cardiac MRI is highly sensitive in confirming viral myocardial inflammation. The correlation of CVD risk factors, cardiac imaging, and biomarkers helped identify negative prognostic indicators in young people recovering from COVID-19.