Study Uncovers High Rates of Abnormal Imaging Findings in Long Covid

In a groundbreaking prospective study published in the Journal of Nuclear Medicine, researchers have revealed that a substantial majority of patients suffering from Long Covid exhibit significant abnormalities in advanced imaging studies. The study, led by Dr. Maria Giovanna Trivieri, an Associate Professor of Cardiology at Mount Sinai Health System, involved 98 participants with persistent cardiopulmonary symptoms persisting nine to twelve months post-COVID-19 infection. Among the findings, 57% of patients presented with abnormalities on positron emission tomography/magnetic resonance imaging (PET/MRI), while an overwhelming 90% showed anomalies on dual-energy computed tomography (DECT).

The cohort, with a median age of 48.5 years, highlighted that nearly one in four subjects had cardiac involvement suggestive of myocarditis as indicated by PET/MRI results. These findings raise critical concerns about the long-term impacts of COVID-19 on cardiovascular health. The study included a control group of nine patients who had a history of severe acute respiratory syndrome (SARS) but did not display cardiopulmonary symptoms, thus providing a comparative baseline.

The imaging studies showed that 30% of those with PET/MRI abnormalities exhibited vascular uptake in either the aorta or pulmonary arteries. This stark contrast to the control group's results, where no myocardial, pericardial, or periannular uptake was detected, emphasizes the potential for lasting cardiac damage in Long Covid patients. Furthermore, 24% of the participants exhibited abnormal findings suggestive of myocarditis, while 22% had indications of pericarditis, and 11% demonstrated periannular uptake on PET/MRI scans.

The significance of these findings is underscored by the correlation between imaging outcomes and distinct serum biomarker profiles. Dr. Trivieri stated, "Our results suggest that Long Covid patients with cardiopulmonary symptoms have unique plasma protein profiles that may be indicative of specific immune mechanisms contributing to the diverse manifestations of this condition."

Moreover, 67% of the patients with Long Covid exhibited pulmonary infiltrates on DECT, and 59% had abnormal perfusion. Notably, those with myocardial involvement showed the highest prevalence of these abnormalities, with 100% of participants with myocardial involvement demonstrating abnormal DECT findings.

The implications of this study are profound. The potential link between abnormal imaging findings and an increased risk of heart failure is particularly concerning. Although the study did not reach statistical significance due to its sample size, the odds ratio for heart failure risk in patients with abnormal PET/MRI findings was calculated at 3.4. This suggests that these imaging abnormalities could serve as critical indicators for future cardiovascular complications in Long Covid patients. Dr. Trivieri and her team noted that 9% of the cohort had developed heart failure, with a significant percentage showing myocardial and pericardial involvement on their PET/MRI scans.

However, the study authors also acknowledged certain limitations, including the relatively small sample size and the potential for patient selection bias, as most participants were self-referred to specialists. Such factors could impact the generalizability of the findings. Nonetheless, the study contributes to the growing body of evidence surrounding Long Covid and its potential long-term health effects.

As research continues, the need for larger studies to substantiate these findings is critical. Understanding the relationship between imaging abnormalities and the clinical outcomes in Long Covid patients will be essential for developing targeted treatment strategies and improving patient care moving forward.