Магнитно-резонансная томография в диагностике вирусных миокардитов у пациентов с COVID-19: нерешенные проблемы

Т.В. Ильина, А.А. Плешко, Т.И. Короткая, Н.П. Митьковская

ГУ «РНПЦ «Кардиология», УО «Белорусский государственный медицинский университет», УЗ «Городская клиническая больница скорой медицинской помощи г. Минска»

Сердечные проявления COVID-19, включая повреждение миокарда, сопровождающееся гповышением уровня тропонина, являются распространенным явлением. Сообщается о миокардите как о возможном осложнении у пациентов с коронавирусом, однако прямые доказательства миокардита на фоне SARS-CoV-2 остаются ограниченными. Описанные серии патоморфологических характеристик, относящиеся к миокардиту при COVID-19, различаются по степени выраженности и интерпретации. Клинические проявления неишемического повреждения миокарда неспецифичны, дифференциальная диагностика еще более затруднена на фоне осложнений вирусной пневмонии. Магнитно-резонансная томография (МРТ) является мощным инструментом для исследования структурно-функциональных изменений сердца при миокардиальном повреждении; новые импульсные последовательности параметрического картирования с определением времени Т1 и Т2 релаксации миокарда – уникальный метод для количественной оценки тканевых характеристик миокарда. Коллективом авторов проведен ретроспективный анализ результатов МРТ 45 пациентов с COVID-19, направленных на МРТ сердца в ГУ «РНПЦ Кардиология» за 6 месяцев 2021 года. Удельный вес пациентов с положительными критериями миокардита Lake Louise составил 18% (n = 8), в структуре патологических изменений самым частым изменением тканевых характеристик миокарда было повышение референсных значений T2 ≥ 2σ в 33%. Среди опубликованных данных о повреждении миокарда существует значительная вариативность в частоте выявления миокардита, связанная с методологическими различиями в исследованиях и разночтениями в интерпретации данных параметрических МР-последовательностей. Этот краткий обзор имеет целью пересмотреть и обобщить текущие знания о миокардите у пациентов с COVID-19, подчеркнуть проблемы, связанные с МРТ-диагностикой.

ключевые слова: коронавирусная инфекция, COVID-19, SARS-CoV-2, МРТ сердца, острый миокардит, повреждение миокарда

для цитирования: Т.В. Ильина, А.А. Плешко, Т.И. Короткая, Н.П. Митьковская. Магнитно-резонансная томография в диагностике вирусных миокардитов у пациентов с COVID-19: нерешенные проблемы. Неотложная кардиология и кардиоваскулярные риски, 2021, Т. 5, № 2, С. 1386–1394

Cardiac magnetic resonance imagining in viral myocarditis in patients with COVID-19: unsolved problems

T. Ilyina, A. Pleshko, T. Korotkaya, N. Mitkovskaya

Cardiac manifestations in COVID-19, including myocardial injury with elevated troponin levels, are common. Myocarditis has been reported as a possible complication in coronavirus patients, but direct evidence for SARS-CoV-2 myocarditis remains limited. The described series of histopathological confirmations of myocarditis in COVID-19 differ in severity and interpretation. Clinical manifestations of non-ischemic myocardial injury are nonspecific, differential diagnosis is even more difficult due to the complications after viral pneumonia. Cardiac Magnetic Resonance Imaging (CMRI) is a powerful tool for studying structural and functional changes in myocardial injury. New pulse sequences of parametric mapping with determination of the T1 and T2 relaxation times of the myocardium are a unique method for quantitative assessment of the myocardium tissue. Within 6 months in 2021, we retrospectively analyzed the CMRI results of 45 patients with COVID-19 at the Republican Scientific and Practical Center “Cardiology”. The percentage of patients with positive criteria for Lake Louise myocarditis was 18% (n = 8). The elevated reference values of T2 ≥ 2σ up to 33% was the most frequent pathological change in myocardial tissue characteristics. There is significant variability in the published data collection as to the prevalence of myocarditis associated with different research methodologies in studies and discrepancies in the interpretation of MRI-mapping data. This brief review is aimed at revising and summarizing current knowledge on myocarditis in COVID-19 patients and highlight the problems of CMRI diagnostics.

keywords: coronavirus infection, COVID-19, SARS-CoV-2, cardiac MRI, acute myocarditis, myocardial injury

for references: T. Ilyina, A. Pleshko, T. Korotkaya, N. Mitkovskaya. Cardiac magnetic resonance imagining in viral myocarditis in patients with COVID-19: unsolved problems. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2021, vol. 5, no. 2, pp. 1386–1394

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