Background: Many COVID-19 survivors experience persistent COVID-19
related cardiac abnormalities weeks to months after recovery from acute
SARS-CoV-2 infection. Non-invasive cardiac magnetic resonance (CMR) imaging is an
important tool of choice for clinical diagnosis of cardiac dysfunctions. In this
systematic review, we analyzed the CMR findings and biomarkers of COVID-19
related cardiac sequela after SARS-CoV-2 infection. Methods: Following
the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA),
we conducted a systematic review of studies that assessed COVID-19 related
cardiac abnormalities using cardiovascular magnetic resonance imaging. A total of
21 cross-sectional, case-control, and cohort studies were included in the
analyses. Results: Ten studies reported CMR results 3 months after
SARS-CoV-2 infection and 11 studies 3 months after SARS-CoV-2 infection.
Abnormal T1, abnormal T2, elevated extracellular volume, late gadolinium
enhancement and myocarditis was reported less frequently in the 3-month
studies. Eight studies reported an association between biomarkers and CMR
findings. Elevated troponin was associated with CMR pathology in 5/6 studies,
C-reactive protein in 3/5 studies, N-terminal pro-brain natriuretic peptide in
1/2 studies, and lactate dehydrogenase and D-dimer in a single study. The rate of
myocarditis via CMR was 18% (154/868) across all studies. Most SARS-CoV-2
associated CMR abnormalities resolved over time. Conclusions: There were
CMR abnormalities associated with SARS-CoV-2 infection and most abnormalities
resolved over time. A panel of cardiac injury and inflammatory biomarkers could
be useful in identifying patients who are likely to present with abnormal CMR
pathology after COVID-19. Multiple mechanisms are likely responsible for COVID-19
induced cardiac abnormalities.