ABC | Volume 115, Nº1, July 2020

Review Article Costa et al. Cardiovascular Imaging and Interventional Procedures Arq Bras Cardiol. 2020; 115(1):111-126 electrocardiographic changes not explained by use of other methods can be candidates to undergo CMRI. 16 Myocarditis and Takotsubo syndrome are suggested etiologies of the SARS- CoV-2-related ventricular dysfunction. 23,25,39,40 The diagnosis of myocarditis follows the same criterion of the other etiologies, usually using the Lake Louise diagnostic criteria, which comprise the presence of regional or global ventricular dysfunction, myocardial edema, pericarditis and/ or non-ischemic delayed enhancement. 41-43 Left ventricular function can be preserved in some patients with myocarditis. 43 The protocol recommended should be the shortest possible, aimed at answering the clinician’s questions. 44 Regarding an elective exam already scheduled, its deferral can be considered if the requesting physician understands that does not increase the risk to the patient. The physician in charge of the exam should decide together with the requesting one about the safety for the patient of postponing the exam (Figure 3). If deciding upon performing the exam, the lowest number of professionals should be in contact with the patient. Safety measures should be taken during the entire procedure and patient’s transportation. 16 Healthcare professionals should be well educated on the proper use of PPE. Whenever possible, one imaging device should be dedicated to patients with suspected or confirmed COVID-19. Device and room cleaning should be performed after the exam. 45 5. Interventional Procedures The COVID-19 pandemic has imposed an unprecedented stress to healthcare systems worldwide. More than ever, the situation calls for extraordinary efficiency in the use of resources and increases the need for fair, consistent, ethical, and efficient healthcare provision. The decision about performing an interventional cardiology procedure amidst a pandemic should balance the risk of healthcare staff’s exposure to the virus, the unnecessary use of resources, and the potential benefit to the patient. 5.1. Human Resources Each service should take proper measures to separate workers into groups, so that possible quarantines can be applied to groups inside each service and not to the entire service. The elderly (age > 65 years), individuals with chronic heart or pulmonary disease, DM or AH are at higher risk of severe disease after COVID-19. Thus, minimizing the direct exposure of healthcare personnel with those characteristics to cases of presumed or confirmed COVID-19 might be advisable. Figure 3 – Recommendations for performing cardiac magnetic resonance imaging (CMRI) during the COVID-19 pandemic. 117