Author + information
- Received May 19, 2020
- Revision received June 25, 2020
- Accepted June 29, 2020
- Published online September 7, 2020.
- Lawrence Rudski, MDa,
- James L. Januzzi, MDb,
- Vera H. Rigolin, MDc,
- Erin A. Bohula, MD, DPhild,
- Ron Blankstein, MDd,
- Amit R. Patel, MDe,
- Chiara Bucciarelli-Ducci, MD, PhDf,
- Esther Vorovich, MD, MSCEc,
- Monica Mukherjee, MD, MPHg,
- Sunil V. Rao, MDh,
- Rob Beanlands, MDi,
- Todd C. Villines, MDj,
- Marcelo F. Di Carli, MDd,∗ (, )@mdicarli@JJheart_doc,
- for the Expert Panel From the ACC Cardiovascular Imaging Leadership Council
- aJewish General Hospital, McGill University, Montreal, Quebec, Canada
- bMassachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- cNorthwestern University Feinberg School of Medicine, Chicago, Illinois
- dBrigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- eUniversity of Chicago, Chicago, Illinois
- fBristol Heart Institute, University of Bristol, Bristol, United Kingdom
- gJohns Hopkins University, Baltimore, Maryland
- hDuke University Health System, Durham, North Carolina
- iOttawa Heart Institute, Ottawa, Ontario, Canada
- jUniversity of Virginia Health System, Charlottesville, Virginia
- ↵∗Address for correspondence:
Dr. Marcelo F. Di Carli, Brigham and Women’s Hospital, ASB-L1 037C, 75 Francis Street, Boston, Massachusetts 02115.
• COVID-19 infections frequently associate with cardiac injury, which increases the risk of morbidity and mortality.
• Advanced imaging facilitate diagnosis but should be used to inform a change in management.
• The impact of imaging on patient management during the chronic phase of COVID-19 warrants additional investigation.
Standard evaluation and management of the patient with suspected or proven cardiovascular complications of coronavirus disease-2019 (COVID-19), the disease caused by severe acute respiratory syndrome related-coronavirus-2 (SARS-CoV-2), is challenging. Routine history, physical examination, laboratory testing, electrocardiography, and plain x-ray imaging may often suffice for such patients, but given overlap between COVID-19 and typical cardiovascular diagnoses such as heart failure and acute myocardial infarction, need frequently arises for advanced imaging techniques to assist in differential diagnosis and management. This document provides guidance in several common scenarios among patients with confirmed or suspected COVID-19 infection and possible cardiovascular involvement, including chest discomfort with electrocardiographic changes, acute hemodynamic instability, newly recognized left ventricular dysfunction, as well as imaging during the subacute/chronic phase of COVID-19. For each, the authors consider the role of biomarker testing to guide imaging decision-making, provide differential diagnostic considerations, and offer general suggestions regarding application of various advanced imaging techniques.
The views expressed in this paper by the American College of Cardiology’s Cardiovascular Imaging Leadership Council do not necessarily reflect the views of the Journal of the American College of Cardiology or the American College of Cardiology.
Dr. Bucciarelli-Ducci is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the UK National Institute for Health Research or the UK Department of Health and Social Care.
Dr. Rudski has minor stock holdings in General Electric outside of a managed portfolio. Dr. Januzzi is a trustee of the American College of Cardiology; is a board member of Imbria Pharmaceuticals; has received grant support from Novartis Pharmaceuticals and Abbott Diagnostics; has received consulting income from Abbott Diagnostics, Janssen, Novartis, and Roche Diagnostics; and has participated in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, CVRx, Janssen, and Takeda. Dr. Bohula has received institutional grant support from Amgen, Novartis, AstraZeneca, Eisai, and The Medicines Company; and has consulted for Kowa, Novo Nordisk, Amgen, and Medscape. Dr. Blankstein has received research support from Amgen Inc. and Astellas Inc. Dr. Patel received research grants from General Electric and Philips. Dr. Vorovich has served on the Speakers Bureau for Abiomed. Dr. Rao has received institutional research grants from Svelte Inc., Shockwave Medical, and Bayer. Dr. Beanlands has received research grants and consulting honoraria from Lantheus Medical Imaging, Jubilant DraxImage, and GE Healthcare. Dr. Di Carli has received institutional grant support from Gilead Sciences and Spectrum Dynamics; and has received consulting income from Janssen and Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Daniel S. Berman, MD, served as Guest Associate Editor for this paper. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received May 19, 2020.
- Revision received June 25, 2020.
- Accepted June 29, 2020.
- 2020 American College of Cardiology Foundation
- Central Illustration
- COVID-19 Testing and Implications for Imaging
- Role of Biomarkers to Inform Imaging Decision-Making in COVID-19
- Clinical Presentations
- Clinical Scenario 1: Chest Pain and Abnormal ECG
- Clinical Scenario 2: Hemodynamic Instability (Shock or Hypotension)
- Clinical Scenario 3: New LV Dysfunction Without Shock or Hypotension
- Clinical Scenario 4: Subacute/Chronic Phase
- Summary and Conclusions