Initial COVID-19 symptoms are not predictive of post-COVID recovery inflammatory heart disease detected by cardiac MRI
Authors: Thodeti S T , Lattanzio D S L , Drenic D D , Kuraan T M K , Khalid M U K , Vallabhaneni S V V , Mikolich J R M 
Published: October 2021

Abstract

Introduction
Intuitively, severity of symptoms usually correlates with severity of disease process or disease progression. In this regard, the ACC Sports and Exercise Cardiology Section proposed an algorithm for competitive athletes to assess and manage cardiac injury after COVID-19 infection based on initial symptoms. However, there are no published, evidence-based data to substantiate this approach.

Purpose
This study was designed to assess the correlation between symptoms at the time of initial diagnosis to post-COVID recovery cardiac symptoms and findings on a cardiac MRI study (CMR). It is hypothesized that the initial symptoms at the time of a positive COVID-19 test may not be reliable or sufficient in predicting the severity of post-COVID recovery symptoms or findings on CMR.

Methods
An institutional cardiac imaging database was queried for all patients with a positive COVID-19 PCR test, who subsequently underwent a CMR for post-COVID recovery cardiac symptoms. Severity of COVID-19 symptoms were assessed using a checklist of mild symptoms and more severe symptoms as defined by the Centers for Disease Control, Atlanta GA. Mild symptoms included: fever/chills, cough, fatigue, body aches, headache, loss of taste/smell, sore throat, congestion, and nausea vomiting diarrhea. More severe symptoms included: shortness of breath, chest pain, and confusion. For each patient, prevalence of these symptoms was assessed at the time of initial diagnosis, and then again post-COVID recovery, just prior to the time of CMR. Inflammatory heart disease (IHD) was defined as pericarditis and/or myocarditis using the recently modified Lake Louise criteria, including T1 and T2 relaxation mapping.

Results
58 patients with a positive COVID-19 PCR test were identified, who subsequently underwent a CMR study for evaluation of cardiac symptoms. 36 patients (62%) had no symptoms at the time of initial diagnosis, while 7 patients (12%) had mild symptoms. Lastly, 15 patients (26%) had more severe symptoms at the time of initial diagnosis. All CMR studies were prompted by the subsequent development of shortness of breath or chest pain. Detection rates of IHD in these 3 groups of patients is delineated in Figure 1. A chi-squared test was used to assess any statistically significant differences in the CMR detection rate of IHD based on initial symptoms. There was no significant difference in the likelihood of IHD based on initial COVID symptoms (p-value=0.856).

Conclusion
Forty-three of 58 patients (74%) with no/mild symptoms at the time of initial COVID-19 diagnosis developed more severe post-COVID symptoms requiring CMR. In contrast, 15 of 58 patients (26%) with more severe symptoms at the time of initial COVID-19 diagnosis had persistence of these symptoms requiring CMR. These data suggest that the severity of symptoms on initial presentation with COVID-19 does not predict post-COVID recovery symptoms or CMR findings of inflammatory heart disease.

Funding Acknowledgement
Type of funding sources: None.