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Table 2 Findings on cardiac “triad” testing following COVID-19 infection that should prompt CMR

From: Utilization of cardiovascular magnetic resonance (CMR) imaging for resumption of athletic activities following COVID-19 infection: an expert consensus document on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention (CVRI) Leadership and endorsed by the Society for Cardiovascular Magnetic Resonance (SCMR)

12-Lead ECG*†

ST-segment depression (\(\ge\) 1 mm in depth in 2 or more contiguous leads, excluding aVR, III, V1)

ST-segment elevation with convex ST morphology (to differentiate from early repolarization)

QRS prolongation

• Right bundle branch block (QRS duration > 140 ms)

• Left bundle branch block (QRS duration > 120 ms)

• Inter-ventricular conduction delay (QRS duration > 120)

Multiple premature ventricular extrasystoles (\(\ge\) 2 PVE per 10 s ECG capture)

Pathologic Q-waves (Q/R ratio \(\ge\) 0.25 or \(\ge 40\) ms duration in 2 or more leads excluding III and aVR)

Myocardial necrosis biomarkers*

Conventional or high sensitivity troponin level > ULN acquired > 24 h after exercise

Transthoracic echocardiography*‡

Global systolic LV dysfunction (LVEF < 50% / LVEF < 45% endurance athlete) with or without LV dilation

Regional/focal LV systolic dysfunction

Increased wall thickness (> 13 mm) with or without chamber dilation

Small or greater pericardial effusion

Intracavitary thrombus

  1. ECG electrocardiogram, CMR cardiac magnetic resonance, ULN upper limit of normal, LV left ventricular, LVEF left ventricular ejection fraction
  2. * Adopted from Ferreira et al. [27]
  3. Adopted from Sharma et al. [70]
  4. Adopted from Baggish et al. [71]