Extended Data Fig. 4

Myocarditis associated with acute COVID-19 infection. A 51-year-old woman with no relevant past medical history presented with chest pain and dyspnoea. She had tested PCR-positive for SARS-CoV-2 in the community 8 days previously. She experienced breathlessness, anosmia, fever, and central chest pain which radiated to her jaw. A 12-lead electrocardiogram revealed T wave flattening laterally (a) and the peak concentration of high sensitivity troponin-1 was 56 ng/L. No further episodes of chest pain occurred. Research-indicated computed tomography (CT) (b, c) and cardio-renal magnetic resonance imaging (MRI) (e, f, g) were acquired in line with the protocol 27 days after discharge from hospital. There was no evidence of pulmonary embolism or COVID-19 pneumonitis (B). On coronary CT angiography, there was no angiographic evidence of atherosclerosis and the FFRct values were normal (d). In the inferior wall of the left ventricle (white arrow), localized, mid-wall elevations in myocardial native T2 (E, 54 ms) and T1 (F, 1313 ms) relaxation times, indicative of acute myocardial inflammation, co-localized with sub epicardial myocardial late gadolinium enhancement (g). These imaging features are diagnostic of myocarditis. The cardiac diagnosis adjudicated by the clinical event committee was myocarditis secondary to COVID-19.