心脏磁共振对COVID-19轻症患者心肌损伤的诊断价值

doi:10.3969/j.issn.1674-8115.2026.03.006

摘要/Abstract

摘要：

目的·基于心脏磁共振（cardiac magnetic resonance，CMR）构建新型冠状病毒感染（coronavirus disease 2019，COVID-19）轻症患者心肌损伤的诊断模型。方法·纳入2024年1月—2025年6月就诊于上海交通大学医学院附属第六人民医院的COVID-19核酸检测阳性并伴有心血管症状的患者64例；患者均于感染后6个月内完成肌钙蛋白I（cardiac troponin I，cTnI）检测及CMR检查。依据cTnI水平将患者分为cTnI升高组［cTnI（+）组，n=26］、cTnI未升高组［cTnI（-）组，n=38］，并纳入年龄、性别匹配的37例未感染COVID-19的人群作为健康对照组。收集并比较3组受试者的基线临床资料、CMR参数（包括心功能与容积参数、左心室整体及节段心肌应变参数、心肌组织学参数）。采用Spearman秩相关分析评估cTnI与基线临床资料及CMR参数的相关性。通过单因素和多因素Logistic回归分析构建能够早期识别COVID-19相关心肌损伤的诊断模型。采用受试者操作特征（receiver operator characteristic，ROC）曲线及Delong检验验证该模型的判别效能。结果·心功能与容积参数对比分析显示，左心室射血分数（left ventricular ejection fraction，LVEF）等指标的组间差异无统计学意义。与健康对照组相比，cTnI（+）组患者的左心室整体周向应变（global circumferential strain，GCS）、左室基底段周向应变（left ventricular basal-level circumferential strain，CS_Basal）、左室中段周向应变（left ventricular mid-level circumferential strain，CS_Mid）有所降低（均P<0.001），Native T1 mapping值有所升高（P<0.001）；cTnI（-）组患者的Native T1 mapping值也有升高（P=0.007）。相关性分析显示，cTnI与CS_Mid呈显著负相关（r=‒0.600，P<0.001）。多因素Logistic回归分析显示，CS_Mid和Native T1 mapping均为COVID-19相关心肌损伤的独立预测因子（均P<0.001）。ROC曲线显示，基于CS_Mid与Native T1 mapping构建的联合诊断模型具有良好的判别效能（AUC=0.950）。结论·基于CS_Mid与Native T1 mapping的CMR联合诊断模型能够有效识别COVID-19轻症患者的潜在心肌损伤，或可为COVID-19相关心肌损伤的早期识别和临床评估提供客观影像学依据。

关键词: 新型冠状病毒感染, 心肌损伤, 心肌应变, Native T1 mapping, 心脏磁共振

Abstract:

Objective ·To establish a cardiac magnetic resonance (CMR)-based diagnostic model for detecting myocardial injury in patients with mild coronavirus disease 2019 (COVID-19). Methods ·A total of 64 patients with positive nucleic acid test results for COVID-19 and accompanying cardiovascular symptoms who visited Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, between January 2024 and June 2025 were enrolled. All patients underwent cardiac troponin I (cTnI) testing and CMR examination within 6 months after infection. According to cTnI levels, patients were divided into an elevated cTnI group [cTnI(+), n=26] and a non-elevated cTnI group [cTnI(-), n=38]. In addition, 37 age- and gender- matched individuals without prior COVID-19 infection were included as healthy controls. Baseline clinical characteristics and CMR parameters, including cardiac function and volumetric parameters, left ventricular global and segmental strain parameters, and myocardial tissue characterization parameters, were collected and compared among the three groups. Spearman rank correlation analysis was performed to evaluate the associations between cTnI and baseline clinical characteristics as well as CMR parameters. Univariate and multivariate Logistics regression analyses were used to establish a diagnostic model for early identification of COVID-19-related myocardial injury. Receiver operator characteristic (ROC) curve analysis and the DeLong test were used to assess the discriminative performance of the model. Results ·Comparative analysis of cardiac function and volumetric parameters showed no significant differences in indices such as left ventricular ejection fraction (LVEF) among the three groups. Compared with the healthy control group, the cTnI(+) group showed decreased left ventricular global circumferential strain (GCS), left ventricular basal-level circumferential strain (CS_Basal), and left ventricular mid-level circumferential strian (CS_Mid) (P<0.001), as well as increased Native T1 mapping values (P<0.001); the cTnI(-) group also showed elevated Native T1 mapping values (P=0.007). Correlation analysis showed that cTnI was significantly negatively correlated with CS_Mid (r=‒0.600, P<0.001). Multivariate Logistic regression analysis revealed that CS_Mid and Native T1 mapping were independent predictors of COVID-19-related myocardial injury (P<0.001). ROC curve analysis showed that the combined diagnostic model based on CS_Mid and Native T1 mapping demonstrated good discriminative performance (AUC=0.950). Conclusion ·The CMR-based diagnostic model combining CS_Mid and Native T1 mapping can effectively identify potential myocardial injury in patients with mild COVID-19. It may provide objective imaging evidence for the early detection and clinical evaluation of COVID-19-related myocardial injury.

Key words: coronavirus disease 2019 (COVID-19), myocardial injury, myocardial strain, Native T1 mapping, cardiac magnetic resonance (CMR)

中图分类号:

R542.2

旦增曲央, 肖活源, 张清晨, 刘雨婷, 康桑, 冯锐, 潘静薇. 心脏磁共振对COVID-19轻症患者心肌损伤的诊断价值[J]. 上海交通大学学报（医学版）, 2026, 46(3): 322-331.

Quyang Danzeng, Xiao Huoyuan, Zhang Qingchen, Liu Yuting, Kang Sang, Feng Rui, Pan Jingwei. Diagnostic value of cardiac magnetic resonance for myocardial injury in patients with mild COVID-19 infection[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(3): 322-331.

图/表 8

表1 3组受试者的基线临床资料比较

Tab 1 Comparison of baseline clinical characteristics among the three groups

Variable	Overall (n=101)	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	P value
Age/year	32.00 (25.00, 41.00)	32.00 (24.00, 42.00)	29.50 (25.00, 38.75)	36.50 (28.00, 40.75)	0.273
Male/n%	49 (48.51)	17 (45.95)	19 (73.08)	13 (34.21)	0.009
Time interval between symptom onset and CMR examination/n%					<0.001
1 week	32 (31.68)	0 (0)	18 (69.23)	14 (36.84)
2 week	12 (11.88)	0 (0)	5 (19.23)	7 (18.42)
1 month	16 (15.84)	0 (0)	3 (11.54)	13 (34.21)
3 month	2 (1.98)	0 (0)	0 (0)	2 (5.26)
6 month	2 (1.98)	0 (0)	0 (0)	2 (5.26)
Symptoms at presentation/n%					<0.001
Chest tightness	11 (10.89)	0 (0)	5 (19.23)	6 (15.79)
Chest pain	23 (22.77)	0 (0)	10 (38.46)	13 (34.21)
Palpitation	14 (13.86)	0 (0)	2 (7.69)	12 (31.58)
Dizziness	10 (9.90)	0 (0)	8 (30.77)	2 (5.26)
Fatigue	4 (3.96)	0 (0)	1 (3.85)	3 (7.89)
Other symptoms	2 (1.98)	0 (0)	0 (0)	2 (5.26)
Comorbidity/n%					<0.001
Positive	5 (4.95)	0 (0)	3 (11.53)	2 (5.26)
Negative	96 (95.05)	37 (100.00)	23 (88.46)	36 (94.74)

表2 3组受试者左心室功能与容积参数的比较

Tab 2 Comparison of left ventricular function and volumetric parameters among the three groups

Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	P value
Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	All	Control vs cTnI(+)	Control vs cTnI(-)	cTnI(+) vs cTnI(-)
LVEF/%	63.60 $±$ 6.15	62.24 $±$ 7.99	63.61 $±$ 6.31	0.672	0.269	0.996	0.447
LVEDV/mL	117.11 (89.39, 131.87)	103.76 (87.43, 133.41)	113.30 (93.08, 139.83)	0.562	0.388	0.971	0.328
LVESV/mL	39.95 (34.87, 51.58)	38.32 (35.14, 49.57)	38.56 (31.85, 57.64)	0.949	0.742	0.979	0.823
LVSV/mL	73.22 (59.30, 83.28)	65.75 (53.35, 81.94)	70.90 (59.03, 85.21)	0.440	0.281	0.998	0.204

表2 3组受试者左心室功能与容积参数的比较

Tab 2 Comparison of left ventricular function and volumetric parameters among the three groups

Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	P value
Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	All	Control vs cTnI(+)	Control vs cTnI(-)	cTnI(+) vs cTnI(-)
LVEF/%	63.60 $±$ 6.15	62.24 $±$ 7.99	63.61 $±$ 6.31	0.672	0.269	0.996	0.447
LVEDV/mL	117.11 (89.39, 131.87)	103.76 (87.43, 133.41)	113.30 (93.08, 139.83)	0.562	0.388	0.971	0.328
LVESV/mL	39.95 (34.87, 51.58)	38.32 (35.14, 49.57)	38.56 (31.85, 57.64)	0.949	0.742	0.979	0.823
LVSV/mL	73.22 (59.30, 83.28)	65.75 (53.35, 81.94)	70.90 (59.03, 85.21)	0.440	0.281	0.998	0.204

表3 3组受试者左心室整体及节段心肌应变参数的比较

Tab 3 Comparison of global and segmental left ventricular strain parameters among the three groups

Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	P value
Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	All	Control vs cTnI(+)	Control vs cTnI(-)	cTnI(+) vs cTnI(-)
GRS/%	30.20 (27.80, 39.01)	30.24 (27.21, 43.19)	32.62 (28.52, 37.93)	0.990	0.933	0.344	0.880
GCS/%	-20.87 $±$ 2.55	-17.38 $±$ 3.03	-20.27 $±$ 2.72	<0.001	<0.001	0.352	<0.001
GLS/%	-14.68 $±$ 3.33	-13.48 $±$ 3.14	-13.86 $±$ 2.91	0.288	0.153	0.911	0.621
CS_Basal/%	-18.86 $±$ 3.24	-15.18 $±$ 3.60	-17.46 $±$ 2.98	<0.001	<0.001	>0.999	0.008
CS_Mid/%	-20.97 $±$ 2.47	-16.04 $±$ 2.93	-20.32 $±$ 2.53	<0.001	<0.001	0.326	<0.001
CS_Api/%	-23.14 (-24.56, -21.06)	-22.54 (-25.57, -19.88)	-24.81 (-27.47, -22.47)	0.035	0.775	0.231	0.027

表3 3组受试者左心室整体及节段心肌应变参数的比较

Tab 3 Comparison of global and segmental left ventricular strain parameters among the three groups

Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	P value
Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	All	Control vs cTnI(+)	Control vs cTnI(-)	cTnI(+) vs cTnI(-)
GRS/%	30.20 (27.80, 39.01)	30.24 (27.21, 43.19)	32.62 (28.52, 37.93)	0.990	0.933	0.344	0.880
GCS/%	-20.87 $±$ 2.55	-17.38 $±$ 3.03	-20.27 $±$ 2.72	<0.001	<0.001	0.352	<0.001
GLS/%	-14.68 $±$ 3.33	-13.48 $±$ 3.14	-13.86 $±$ 2.91	0.288	0.153	0.911	0.621
CS_Basal/%	-18.86 $±$ 3.24	-15.18 $±$ 3.60	-17.46 $±$ 2.98	<0.001	<0.001	>0.999	0.008
CS_Mid/%	-20.97 $±$ 2.47	-16.04 $±$ 2.93	-20.32 $±$ 2.53	<0.001	<0.001	0.326	<0.001
CS_Api/%	-23.14 (-24.56, -21.06)	-22.54 (-25.57, -19.88)	-24.81 (-27.47, -22.47)	0.035	0.775	0.231	0.027

表4 3组受试者的左心室心肌组织特征参数的比较

Tab 4 Comparison of left ventricular myocardial tissue characterization parameters among the three groups

Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	P value
Variable	Control group (n=37)	cTnI(+) group (n=26)	cTnI(-) group (n=38)	All	Control vs cTnI(+)	Control vs cTnI(-)	cTnI(+) vs cTnI(-)
T2WI/n(%)				<0.001	<0.001	>0.999	<0.001
Negative	37 (100.00)	16 (61.54)	37 (97.37)
Positive	0 (0)	10 (38.46)	1 (2.63)
Native T1 mapping/ms	1 216.90 (1 189.00, 1 238.69)	1 268.90 (1 248.67, 1 317.00)	1 235.49 (1 203.37, 1 264.05)	<0.001	<0.001	0.007	<0.001
LGE/n(%)				<0.001	<0.001	<0.001	<0.001
Negative	37 (100.00)	2 (7.69)	28 (73.68)
Positive	0 (0)	24 (92.31)	10 (26.32)
LGE/%	/	18.05 (14.43, 22.18)	0.00 (0.00, 8.10)	/	/	/	<0.001
LGE segment/n(%)				<0.001	<0.001	0.004	<0.001
LAT	0 (0)	14 (58.33)	3 (30.00)
ANT	0 (0)	5 (20.83)	5 (50.00)
SEPT	0 (0)	4 (16.67)	1 (10.00)
Other segment	0 (0)	1 (4.17)	1 (10.00)
LGE location/n(%)				<0.001	<0.001	0.003	<0.001
Mid-level	37 (100.00)	2 (8.33)	4 (40.00)
Basal-level	0 (0)	5 (20.83)	3 (30.00)
Apical-level	0 (0)	3 (12.50)	0 (0)
Basal-Mid	0 (0)	6 (25.00)	3 (30.00)
Mid-Apical	0 (0)	5 (20.83)	0 (0)
All-level	0 (0)	3 (12.50)	0 (0)
LGE pattern/n(%)				<0.001	<0.001	<0.001	<0.001
Mid-wall	0 (0)	5 (20.83)	4 (40.00)
Subepicardial	0 (0)	3 (12.50)	1 (10.00)
Mid-Subepi	0 (0)	15 (62.50)	5 (50.00)
Subendocardial	0 (0)	1 (4.17)	0 (0)

图1 代表性病例的LGE与Native T1 mapping影像表现示例Note： A1—A3. LGE images of short-axis slices at basal (A1), mid-ventricular (A2), and apical (A3) levels of the left ventricle. B1—B3. Pre-contrast Native T1 mapping images of corresponding short-axis slices at basal (B1), mid-ventricular (B2), and apical (B3) levels of the left ventricle. Arrows indicate the corresponding regions across sequences.

Fig 1 Representative LGE and Native T1 mapping images of a typical case

表5 cTnI与基线临床资料及CMR参数的相关性分析

Tab 5 Correlation analysis of cTnI with baseline clinical characteristics as well as key CMR parameters

Statistic	Gender	Time interval between symptom onset and CMR examination	T2WI	Native T1 mapping	GCS	CS_Basal	CS_Mid
r	0.383	0.370	-0.466	-0.422	-0.462	-0.366	-0.600
P	0.003	0.003	<0.001	<0.001	0.001	0.003	<0.001

表6 COVID-19相关心肌损伤的单因素和多因素Logistic回归分析

Tab 6 Univariate and multivariate Logistic regression analyses of COVID-19-associated myocardial injury

Variable	Univariate Logistic regression analysis					Multivariate Logistic regression analysis
Variable	β	S.E	Z	P	OR (95% CI)	β	S.E	Z	P	OR (95% CI)
Male	-0.27	0.42	-0.65	0.515	0.762 (0.336‒1.727)
Time interval between symptom onset and CMR examination
1 week					1.000 (Ref)
2 week	0.34	0.68	0.49	0.623	1.400 (0.366‒5.350)
1 month	-0.21	0.62	-0.41	0.683	0.778 (0.233‒2.599)
3 month	0.00	1.46	0.00	1.000	1.000 (0.057‒17.411)
6 month	16.57	1 696.73	0.01	0.992	15 651 360.793 (0.000‒Inf)
Symptoms at presentation
Chest tightness					1.000 (Ref)
Chest pain	-0.27	0.77	-0.37	0.723	0.762 (0.170‒3.422)
Palpitation	-1.35	0.83	-1.63	0.103	0.260 (0.051‒1.313)
Dizziness	0.83	1.10	0.82	0.413	2.286 (0.316‒16.512)
Fatigue	-18.13	1 978.09	-0.01	0.993	0.000 (0.000‒Inf)
Other symptoms	-0.56	1.55	-0.36	0.718	0.57 (0.028‒11.85)
Comorbidity
Negative					1.000 (Ref)
Positive	0.37	0.94	0.39	0.695	1.450 (0.226‒9.319)
Native T1 mapping	0.06	0.01	4.67	<0.001	1.057 (1.032‒1.081)	0.08	0.02	3.40	<0.001	1.080 (1.033‒1.129)
GCS	0.65	0.13	4.92	<0.001	1.917 (1.479‒2.488)
CS_Basal	0.41	0.09	4.54	<0.001	1.511 (1.264‒1.806)
CS_Mid	0.81	0.16	5.09	<0.001	2.239 (1.642‒3.055)	0.94	0.25	3.79	<0.001	2.564 (1.574‒4.175)
CS_Api	0.09	0.06	1.63	0.103	1.099 (0.981‒1.231)

图2 COVID-19相关心肌损伤的联合诊断模型的ROC曲线分析

Fig 2 ROC curve analysis of the combined diagnostic model for COVID-19-associated myocardial injury

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