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.