Impact of daily exercise on myocardial injury and adaptive changes following viral infection: a prospective observational cardiac magnetic resonance study in patients recovered from Omicron
C Pan, H Huang, L Lu, T Jia, X Zhou, F Hu, W Tang, C Ma, Q Liu, J Yang, N Hou, Y Wang, S Li, J ChenAbstract
Background
The cardiovascular protective effects of regular exercise have been well established. Viral infection can lead to myocardial injury, and current research on the impact of exercise on post-viral myocardial injury has primarily focused on competitive athletes, while imaging evidence regarding the effect of daily exercise on myocardial injury in the general population following viral infection remains limited. Cardiac magnetic resonance (CMR) parameters, including myocardial native T1 values for quantifying myocardial tissue characteristics and left ventricular global longitudinal strain (LV GLS) for assessing myocardial motion function, can non-invasively and sensitively detect viral-induced myocardial changes.
Purpose
To investigate the association between daily exercise habits in the general population and changes in myocardial tissue and function following viral infection.
Methods
We prospectively enrolled patients during the convalescent phase of Omicron infection (defined as ≥1 month after symptom resolution or negative viral test) who underwent CMR examination. Patients were grouped according to pre-infection exercise habits and levels of physical activity energy expenditure (PAEE). Myocardial native T1 values and LV GLS were compared between groups.
Results
A total of 54 patients (36 men, 66.7%; mean age 54 ± 12 years) were included, undergoing CMR at 54 ± 12 days after positive viral testing. Myocardial native T1 values were negatively correlated with years of exercise (non-exercise: 1286.1 ± 55.5 msec; ≤5 years: 1244 ± 43.5 msec; >5 years: 1225.7 ± 57.4 msec, P-trend = 0.002) and pre-infection total PAEE (low: 1318.1 ± 39.9 msec; moderate: 1248.1 ± 47.6 msec; high: 1235.9 ± 50.6 msec, P-trend < 0.001). Extracellular volume fraction was also negatively correlated with years of exercise (non-exercise: 35.9 ± 3.8%; ≤5 years: 34.1 ± 5.6%; >5 years: 30.8 ± 4.6%, P-trend = 0.005). The absolute value of LV GLS was significantly higher in the exercise group than in the non-exercise group (-18.1 ± 2.3% vs. -15.8 ± 2.1%, P = 0.004). Multivariable linear regression analysis demonstrated that myocardial native T1 values were independently and negatively associated with pre-infection total PAEE (B coefficient [95% CI]: -25.28 [-41.413, -9.147]; P = 0.003). LVGLS was independently and negatively associated with years of exercise (B coefficient [95% CI]: -2.179 [-3.689, -0.668]; P = 0.006).
Conclusion(s)
Pre-viral infection daily exercise habits are associated with more favorable myocardial tissue characteristics and systolic function following infection, suggesting a cardioprotective role in the general population that may attenuate viral-induced myocardial injury.