Author + information
- Lawrence Rudski, MD1,
- James L. Januzzi, MD2,
- Vera H. Rigolin, MD3,
- Erin A. Bohula, MD, DPhil4,
- Ron Blankstein, MD4,
- Amit R. Patel, MD5,
- Chiara Bucciarelli-Ducci, MD, PhD, FESC, FRCP6,
- Esther Vorovich, MD, MSCE3,
- Monica Mukherjee, MD, MPH7,
- Sunil V. Rao, MD, FSCAI8,
- Rob Beanlands, MD9,
- Todd C. Villines, MD10 and
- Marcelo F. Di Carli, MD4,∗∗ ()
- 1Jewish General Hospital, McGill University, Montreal, Canada
- 2Massachusetts General Hospital, Harvard Medical School, Boston, MA
- 3Northwestern University Feinberg School of Medicine, Chicago, IL
- 4Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- 5University of Chicago, Chicago, IL
- 6Bristol Heart Institute, University of Bristol, Bristol, UK
- 7Johns Hopkins University, Baltimore, MD
- 8Duke University Health System, Durham, NC
- 9Ottawa Heart Institute, Ottawa, Canada
- 10University of Virginia Health System, VA
- ↵∗∗Address for correspondence: Marcelo F. Di Carli, MD, Brigham and Women’s Hospital, ASB-L1 037C, 75 Francis St, Boston, MA 02115 Tel: 617-732-6290 Fax: 617-582-6056
Standard evaluation and management of the patient with suspected or proven cardiovascular complications of 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 sub-acute/chronic phase of COVID-19. For each, we 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.
Condensed Abstract Standard evaluation and management of the patient with suspected or proven cardiovascular complications due to COVID-19 infection often requires advanced imaging techniques to assist in differential diagnosis and management. This document provides guidance in several common scenarios among patients with COVID-19 infection and for each provides advice regarding the role of biomarker testing to guide imaging decision-making, provides differential diagnostic considerations, and offers general suggestions regarding application of various advanced imaging techniques.
Expert panel from the American College of Cardiology (ACC) Cardiovascular Imaging Leadership Council
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, consulting income from Abbott Diagnostics, Janssen, Novartis, and Roche Diagnostics, and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, CVRx, Janssen, and Takeda.
Dr. Patel received research grants from General Electric and Philips.
Dr. Rudski has minor stock holdings in General Electric outside of a managed portfolio.
Dr. Vorovich is on the speakers bureau for Abiomed
Dr. Bohula has received institutional grant support from Amgen, Novartis, Astra Zeneca, Eisai, and The Medicines Company, and consults for Kowa, Novo Nordisk, Amgen, and Medscape.
Dr. Bucciarelli-Ducci receives supported from 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. Di Carli has received institutional grant support from Gilead Sciences and Spectrum Dynamics, and consulting income from Janssen and Bayer.
Dr. Blankstein has received research support from Amgen Inc. and Astellas Inc.
Dr. Rao has received insitutional research grants from Svelte Inc, Shockwave Medical, and Bayer.
Dr. Mukherjee has no disclosures.
Dr. Rigolin has no disclosures.
Dr. Villines has no disclosures.
Dr. Beanlands has received research grants and consulting honoraria from Lantheus Medical Imaging, Jubilant DraxImage, and GE Healthcare.
- Received May 19, 2020.
- Revision received June 25, 2020.
- Accepted June 29, 2020.