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Detection and Classification of Myocardial Injury Using Hybrid CMR/FDG-PET Imaging in Patients Suffering from Long COVID

https://doi.org/10.1007/s00392-025-02625-4

Simon Greulich (Tübingen)1, H. Dittmann (Tübingen)2, J. Brendel (Tübingen)3, K. Nikolaou (Tübingen)3, C. La Fougere (Tübingen)2, M. Gawaz (Tübingen)1, P. Krumm (Tübingen)3

1Universitätsklinikum Tübingen Innere Medizin III, Kardiologie und Angiologie Tübingen, Deutschland; 2Universitätsklinikum Tübingen Nuklearmedizin Tübingen, Deutschland; 3Universitätsklinikum Tübingen Radiologie Tübingen, Deutschland

 

Background: The dissociation between symptoms and routine clinical investigations in long COVID patients underline the need for deeper phenotyping efforts in diagnosing potential myocardial injury.

 

Objectives: This study aimed to assess the feasibility and diagnostic value of hybrid cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in 1) detecting and 2) classifying myocardial injury into chronic active or healed status in long COVID patients.

 

Methods: Thirty-five long COVID patients (age 39 ± 14 years; 51% female) were prospectively enrolled. After dietary preparation to suppress physiological myocardial FDG uptake, patients underwent comprehensive hybrid CMR/FDG-PET imaging. Myocardial injury was classified as chronic active, healed, or absent based on CMR tissue parameters (Late Gadolinium Enhancment (LGE), T1/T2/Extracellular Volume (ECV) mapping), and FDG-PET uptake results.

 

Results: Among the 32 patients with evaluable imaging, n=9 (28%) demonstrated chronic active myocardial injury, characterized by abnormal tissue CMR parameters and focal FDG uptake (CMR+, PET+). Healed myocardial injury was identified in n=17 (53%) patients, with abnormalities in CMR tissue parameters, but no FDG uptake (CMR+, PET-). No myocardial injury was detected in n=6 (19%) patients (CMR-, PET-). 

 

Conclusions: Hybrid CMR/FDG-PET imaging identified myocardial injury in a high proportion of long COVID patients. Our data suggest a high clinical value of hybrid CMR/FDG-PET for the detection and further classification of myocardial injury (chronic active vs. healed status), which might help the treating physician in guiding appropriate clinical management in the increasing number of long COVID patients with persisting symptoms. 

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