麻豆传媒

A call for professional societies to denounce routine post-COVID cardiac MRI (CMR) scans for asymptomatic people got a couple to do so, albeit without any formal published statements or guidance.

"The number one COVID concern in cardiology right now is asymptomatic patients who have been previously infected demonstrating evidence on MRI of scarring or myocarditis," noted Mary Norine Walsh, MD, of St. Vincent Heart Center of Indiana in Indianapolis and past president of the American College of Cardiology (ACC). "We're all concerned about the long-term COVID manifestations."

Such evidence of myocardial injury and inflammation on CMR turned up in a German study among people who recovered from largely mild or moderate cases of COVID-19 compared with healthy controls and risk factor-matched controls.

Then an Ohio State University study showed CMR findings suggestive of myocarditis in 15% of collegiate athletes after asymptomatic or mild SARS-CoV-2 infection.

But an from some 50 medical professionals across disciplines emphasized that "prevalence, clinical significance and long-term implications" of such findings aren't known. The letter called on the 18 professional societies to which it was sent on Tuesday to release clear guidance against CMR screening in the general population to look for post-COVID heart damage in the absence of symptoms.

The Society for Cardiac Magnetic Resonance quickly responded with a from its chief executive officer, Chiara Bucciarelli-Ducci, MD, PhD, agreeing that routine CMR in asymptomatic patients after COVID-19 "is currently not justified... and it should not be encouraged."

She referred clinicians to the multisociety when deciding whether to scan COVID-19 patients. "While CMR is an excellent imaging tool for diagnosing myocarditis in patients with suspected disease, we do not recommend its use in patients without symptoms," she added.

The American Heart Association didn't put out any written statement but offered spokesperson Manesh Patel, MD, chair of its Diagnostic and Interventional Cath Committee.

"The American Heart Association's position on this is that in general we agree that routine cardiac MRI should not be conducted unless in the course of a study" for COVID-19 patients, he said. "There's a lot of evolving information around people with COVID, and certainly asymptomatic status, whether it's recent or prior, it's not clearly known what the MRI findings will mean or what the long-term implications are without both a control group and an understanding around population."

The ACC opted against taking a stand. It provided 麻豆传媒 with the following statement from ACC President Athena Poppas, MD:

"We appreciate the authors' concerns about the potential mischaracterization of the long-term impact of myocarditis after a COVID-19 diagnosis and the need for well-designed clinical trials and careful, long term follow-up. The pandemic is requiring everyone make real-time decisions on how to best care for heart disease patients who may be impacted by COVID-19. The ACC is committed to helping synthesize and provide the most up-to-date, high quality information possible to the cardiovascular care team. We will continue to review and assess the scientific data surrounding cardiac health and COVID-19 and issue guidance to help our care team."

While the open letter noted that some post-COVID patients have been asking for CMR, Walsh noted that primary care would likely see the brunt of any such influx. She personally has not had any patients ask to be screened.

For her heart failure and transplant practice, the question is how COVID-19 will affect heart donation: CMR has not been considered to routinely screen donors, but should it be in the future? How would asymptomatic or mild COVID-19 cases that were never tested and don't show up in the medical record be handled?

"We are in a data-free zone," Walsh said. Even for the long-term cardiac consequences of the CMR findings post-COVID, "we're years away from understanding that."

Special populations -- athletes, but also the elderly and those in nursing homes -- may take a different approach, although what exactly that should be is unclear as well, Patel noted.

The American Medical Society for Sports Medicine, for one, is putting together a registry to understand athletes' health and incorporating COVID-related screening into it, he pointed out.

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