Introduction:
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory
syndrome (SARS) Cov-2 has affected a majority of the global population
in multiple waves of infection.1 Multisystem
involvement in COVID-19 is common with pulmonary and cardiovascular
system being most commonly affected.2 A majority of
subjects often completely recover from COVID-19 infection however, a
proportion of patients might have persistent symptoms despite recovery
from COVID-19. This emerging clinical entity is termed as chronic
COVID-19 syndrome (CCS) or long haul COVID.3 Most of
these patients present with fatigue, chest pain and palpitations with a
marked negative impact on the quality of life. Though the exact etiology
of CCS is still unclear, limited studies have attributed myocardial
injury, ongoing inflammation and sub-clinical myocardial dysfunction to
be the potential causes of CCS.4
Myocardial injury in COVID-19 is not uncommon and has been reported in
up to one-third of patients with COVID-19 infection.5A majority of these patients with acute myocardial injury have severe
COVID-19 infection with raised inflammatory markers and multiple
co-morbidities. Multiple mechanisms have been postulated for myocardial
injury in COVID-19 including the direct viral injury leading to
myocarditis, systemic inflammation and cytokine storm, microvascular
damage and thrombosis.6 Cardiovascular magnetic
resonance (CMR) imaging is the gold standard proven diagnostic modality
to evaluate cardiac structure, function, myocardial scar (late
gadolinium enhancement) and oedema. CMR being a non-invasive imaging
modality can detect the presence and extent of myocardial injury as well
detection of sub-clinical LV dysfunction even before overt regional wall
motion abnormalities become apparent.7 There is
limited data utilising CMR in detection of myocardial
injury/inflammation in COVID-19 recovered
subjects.8-12 In the present study, we assessed CMR
findings in symptomatic COVID-19 recovered patients both at baseline and
at six months of follow-up.