Diagnostic value of cardiac magnetic resonance for myocardial injury in patients with mild COVID-19 infection

doi:10.3969/j.issn.1674-8115.2026.03.006

Abstract

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)

CLC Number:

R542.2

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.

Figures/Tables 8

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)

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

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

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

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

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)

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

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

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)

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

TrendMD

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