The severe acute respiratory syndrome-coronavirus-2 outbreak has rapidly reached pandemic proportions and has become a major threat to global health. Although the predominant clinical feature of coronavirus disease-2019 (COVID-19) is an acute respiratory syndrome of varying severity, ranging from mild symptomatic interstitial pneumonia to acute respiratory distress syndrome, the cardiovascular system can be involved in several ways. As many as 40% of patients hospitalized with COVID-19 have histories of cardiovascular disease, and current estimates report a proportion of myocardial injury in patients with COVID-19 of up to 12%. Multiple pathways have been suggested to explain this finding and the related clinical scenarios, encompassing local and systemic inflammatory responses and oxygen supply-demand imbalance. From a clinical point of view, cardiac involvement during COVID-19 may present a wide spectrum of severity, ranging from subclinical myocardial injury to well-defined clinical entities (myocarditis, myocardial infarction, pulmonary embolism, and heart failure), whose incidence and prognostic implications are currently largely unknown because of a significant lack of imaging data. Integrated heart and lung multimodality imaging plays a central role in different clinical settings and is essential in the diagnosis, risk stratification, and management of patients with COVID-19. The aims of this review are to summarize imaging-oriented pathophysiological mechanisms of lung and cardiac involvement in COVID-19 and to provide a guide for integrated imaging assessment in these patients. Central Illustration Highlights • Cardiac involvement is present in up to 12% of patients with COVID-19. • Multimodality imaging is essential in different clinical settings in COVID-19. • Multimodality imaging is useful in diagnosis, risk stratification, and management. • Strategies for preventing viral transmission during examinations must be adopted.
【저자키워드】 COVID-19, SARS-CoV-2, coronavirus, echocardiography, Computed tomography, Lung ultrasound, chest X-ray, ARDS, acute respiratory distress syndrome, cardiac magnetic resonance, CT, Computed tomography, ICU, Intensive care unit, COVID-19, coronavirus disease-2019, SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2, ED, emergency department, MI, myocardial infarction, GGO, ground-glass opacity, PE, Pulmonary embolism, TTE, Transthoracic echocardiography, CMR, cardiac magnetic resonance, RT-PCR, reverse-transcriptase polymerase chain reaction, multimodality imaging, ACS, acute coronary syndrome(s), CXR, chest radiography, FoCUS, focused cardiac ultrasound, ICA, invasive coronary angiography, LUS, lung ultrasound, MINOCA, myocardial infarction with nonobstructive coronary arteries, PPE, personal protection equipment, TEE, transesophageal echocardiography,