Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

Abstract

Myocardial injury, diagnosed by troponin elevation, is common in COVID-19 patients, but cardiac involvement with clinical manifestations occurs less frequently. We analyzed the literature on COVID-19 (2020) and systematically reviewed the cases where individual patient data were presented. We searched PubMed and Google Scholar for "COVID," "COVID-19," and "coronavirus" in combination with "myocarditis," "heart failure," "takotsubo," "cardiomyopathy," and "cardiogenic shock." We identified 90 cases of COVID-19 with myocardial involvement, mean age 52.9 ± 18.3 years, 54.5% males. Of them, 55 survived (61.1%), 20 died (22.2%), and in 15 (16.7%) the outcome was unknown at the time of publication. Among patients with known outcome, mortality was 26%. The nadir LVEF was 31.7 ± 13.1% and recovered to 50.1 ± 16.0%. Pericardial effusion was a common finding, reported in 21 (23.3%) of patients, including moderate size effusion in 8.9% and large in 7.8%. The effusion caused tamponade in 11 (12.2%) of patients. Out of 83 patients who experienced a decrease in LVEF, 30 could be classified as takotsubo syndrome. The takotsubo patients were older than those with myocarditis, and with relatively high proportion of males. About one third of the cases was complicated by cardiogenic shock. Myocardial involvement in COVID-19 patients most often presents as a new, rapid decrease in LVEF, although normal LVEF or takotsubo-like wall motion pattern does not rule out myocarditis. Moderate and large pericardial effusion is common, and cardiac tamponade occurs in 12.2% of patients. Cardiogenic shock develops in one third of the patients. Mortality appears to be high at 26%.

Microbiological and Clinical Findings of SARS-CoV-2 Infection after 2 Years of Pandemic: From Lung to Gut Microbiota

“…One of the most common is myocarditis that may be characterized by myocardial damage in the absence of ischemic causes and inflammatory infiltrates [ 65 , 66 ]. In almost a third of COVID-19 patients with myocardial involvement, cardiogenic shock occurred [ 67 ] with a mortality of about 26% [ 68 ]. In addition, COVID-19 patients have a high risk of arterial and venous thrombosis [ 69 ].…”

The heart and SARS-CoV-2

“…Myocardial injury seen during SARS-CoV-2 infection may be due to myocardial infarction caused by plaque rupture (type 1 myocardial infarction), increased myocardial demand (type 2 myocardial infarction), or stress cardiomyopathy or myocarditis, all of which leads to increased troponin levels, commonly seen in COVID-19 25 , 26 , 27 . Differential diagnosis between myocardial infarction, myocarditis or stress cardiomyopathy will require conventional complementary tests, among which electrocardiography, echocardiography and cardiac magnetic resonance (CMR) or angiography will be of great importance.…”

An unexpected cause of chest pain, dyspnea and palpitations in a young patient during a post-COVID syndrome

“…In critically ill patients, troponin is often positive because of acute respiratory distress, inflammation, and coagulation disorders (2), even in absence of significative coronary stenosis (3). Previous studies reported the occurrence of a myocardial involvement, defined as increased troponin levels and electrocardiographic abnormalities, among hospitalized COVID-19 patients (4).…”