CMR And Serology To Diagnose COVID-19 Infection With Primary ...

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Article Navigation Article Navigation Journal Article CMR and serology to diagnose COVID-19 infection with primary cardiac involvement Pierre Gravinay, Pierre Gravinay Cardiac Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Nahema Issa, Nahema Issa Intensive Care and Infectious Disease Unit, CHU Bordeaux, Bordeaux, France Search for other works by this author on: Oxford Academic PubMed Google Scholar David Girard, David Girard Medical Biology Laboratory, Groupe Hospitalier Sud Gironde, Langon, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Fabrice Camou, Fabrice Camou Intensive Care and Infectious Disease Unit, CHU Bordeaux, Bordeaux, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Hubert Cochet Hubert Cochet Department of Cardiovascular Imaging, CHU Bordeaux, Pessac, FranceIHU Liryc, CHU/Univ. Bordeaux/Inserm1045, Pessac, France Corresponding author. Unité d’Imagerie Thoracique et Cardiovasculaire, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604, Bordeaux-Pessac, France. Tel: +33 5 57656542, Fax: +33 5 57656509, Email: hubert.cochet@chu-bordeaux.fr Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, Volume 22, Issue 1, January 2021, Page 133, https://doi.org/10.1093/ehjci/jeaa169 Published: 17 June 2020 Article history Received: 14 May 2020 Published: 17 June 2020 Navbar Search Filter European Heart Journal - Cardiovascular ImagingThis issueESC Publications Cardiovascular MedicineBooksJournalsOxford Academic Mobile Enter search term Search Close Navbar Search Filter European Heart Journal - Cardiovascular ImagingThis issueESC Publications Cardiovascular MedicineBooksJournalsOxford Academic Enter search term Search Advanced Search Search Menu graphicOpen in new tabDownload slide

A 51-year-old man presented with fever, arthromyalgia, dyspnoea, and atypical chest pain, but no coughing or anosmia/ageusia. Troponin I was 2900 ng/mL, N-terminal pro-brain natriuretic peptide (NT-proBNP) was 900 pg/mL, C-reactive protein was 270 mg/L, and fibrinogen was >10 g/L. ECG showed non-specific T wave changes (Panel A). Echocardiography was unremarkable. Acute myocarditis was suspected. Two COVID-19 PCR tests on nasopharyngeal swabs were performed within 48 h, along with a chest CT (Panel B), all being negative for the diagnosis of COVID-19. Serological tests showed ancient parvovirus B19 and Epstein–Barr virus (EBV) infection. Other tests were negative (HBV, HCV, HIV, CMV, Coxsackie, HSV1, HSV2, VZV, VRS, and influenza virus). CMR was performed 8 days after the onset of symptoms, showing subepicardial oedema on the lateral/inferior left ventricular (LV) wall (Panel C), with late gadolinium enhancement (Panel D), consistent with acute myocarditis. Cine imaging showed preserved LVEF and volumes, no wall motion abnormalities, but a 5 mm thrombus was present at the LV apex (Panel E). The unusual finding of a clot despite preserved LVEF and the profound biological signs of inflammation were interpreted as uncommon, and a COVID-19 serological test was thus performed (BIOSYNEX COVID-19). Results were positive for SARS-COV-2 immunization on IgG and IgM. The patient was treated with tocilizumab. This report indicates that (i) myocardial involvement can be the primary manifestation of COVID-19 infection; (ii) CMR may arouse the suspicion of the diagnosis by detecting unusual thrombosis within cardiac chambers; and (iii) serological tests are of the utmost importance to obtain diagnostic confirmation in the absence of pulmonary involvement, as PCR and chest CT may be negative.

Conflict of interest: none declared.

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Issue Section: IMAGE FOCUS Download all slides Advertisement intended for healthcare professionals

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