Fulminant myocarditis due to COVID-19

Irabien-Ortiz, Ángela; Carreras-Mora, José; Sionís, Alessandro; Pàmies, Julia; Montiel, José; Taurón, Manel

doi:10.1016/j.rec.2020.04.005

Cited by 79 publications

(109 citation statements)

References 4 publications

(4 reference statements)

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“…Our data is consistent with many previous studies suggesting that patients with abnormal TTE were more likely to die in hospital (13,14,(20)(21)(22). Peng et al have shown that abnormal echocardiography features were linked to the severity of disease and consequent cardiovascular sequelae (23).…”

Section: Discussionsupporting

confidence: 93%

Observations on echocardiographic findings in patients with COVID-19

Khan

James

Yuan

et al. 2020

Preprint

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Background The novel coronavirus (SARS-CoV-2) has created global havoc by causing Coronavirus Disease 2019 (COVID-19). Cardiovascular involvement in COVID-19 varies from troponin rise or arrhythmia/myocarditis to fulminant cardiogenic shock. There is limited data on echocardiographic findings in such patients. We aimed to assess abnormal echocardiographic findings and contributory factors in patients with COVID-19.Methods We performed retrospective analysis of COVID-19 positive patients who underwent a transthoracic echocardiogram (TTE) at Sandwell and West Birmingham (SWBH) NHS Trust between March 2020 and May 2020. Patients were compared based on TTE changes and divided into two groups (abnormal TTE and normal TTE).Results 66 out of 463 patients with COVID-19 had a TTE. 46 patients (69.7%) had abnormal findings on their TTE. Tricuspid regurgitation was the most common abnormality observed (26 (56.5%) patients), followed by aortic regurgitation (13 (28.3%) patients) and mitral regurgitation (12 (26.1%) patients). Haemoglobin and LDH were predictors of abnormal TTE (Hb OR: 0.97, p = 0.049, LDH, OR: 1.00, p = 0.03). Significantly more patients in the abnormal TTE group died during their inpatient stay compared to normal TTE (p = 0.01). Having an abnormal TTE was an independent predictor of death on regression analysis (OR: 0.229, p = 0.034).Conclusions This is the first detailed observational study looking at echocardiographic changes in admitted COVID-19 patients irrespective of disease severity. The most common abnormality was valve regurgitation. Patients with abnormal TTE were more likely to die in hospital.

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Section: Discussionsupporting

confidence: 93%

Observations on echocardiographic findings in patients with COVID-19

Khan

James

Yuan

et al. 2020

Preprint

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“…In patients who are suspected of having COVID-19related acute myocarditis, baseline electrocardiography (ECG) should be carried out on admission. In this review, we observed that ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads [4][5][6][7][8]10,14,17 . Despite frequent changes in ECG, no specific changes were detected in some cases 9,16 .…”

Section: Imaging Featuresmentioning

confidence: 99%

COVID-19 and acute myocarditis: current literature review and diagnostic challenges

Çınar

Hayıroğlu

Çiçek

et al. 2020

Rev. Assoc. Med. Bras.

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SUMMARY INTRODUCTION In the current literature, there has been an upsurge of cases of COVID-19-induced acute myocarditis. In this case-based review, we aimed to describe the clinical characteristics, imaging findings, and in-hospital course of acute myocarditis. In addition, the limitations of the myocarditis diagnosis were discussed since only fulminant myocarditis cases have been mentioned in the current literature. METHODS We performed a review of the literature of all patients who were diagnosed with COVID-19-induced acute myocarditis using the databases of PubMed, Embase, and the Cochrane. RESULTS 16 case reports were found to be related to COVID-19-induced acute myocarditis. We observed that the ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads. Echocardiographic findings of COVID-19-induced acute myocarditis patients ranged from preserved left ventricular ejection fraction (LVEF) without segmental abnormalities to reduced LVEF with global hypokinesia. Interestingly, a few patients with COVID-19-induced acute fulminant myocarditis were steroid-responsive and had an amelioration with glucocorticoid and immunoglobulin therapy. CONCLUSION Despite the COVID-19 pandemic worldwide, a limited number of cases has been shared in the current literature. There are a lot of difficulties in the differential diagnosis of acute myocarditis in the context of COVID-19.

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“…The true frequency of myocarditis complicating COVID-19 is impossible to determine. Using the search terms (“COVID-19” OR “coronavirus” OR “SARS-CoV-2” AND “myocarditis” OR “inflammatory cardiomyopathy”) (date of search 20 th May 2020), we found 15 case reports and a few retrospective cohort studies reporting cardiac complications of COVID-19 ( Table ) 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 . Most of these reports have major limitations and none of them showed biopsy-proven SARS-CoV-2-positive myocarditis.…”

Section: Introductionmentioning

confidence: 99%

“…CMR, the gold standard among non-invasive imaging tools for the diagnosis of clinically suspected myocarditis [ 2 , 19 ], was performed in less than half of the patients 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 . Several descriptions of EMB or autopsies have shown no signs of cardiomyocyte damage with SARS-CoV-2 viral particles located in cardiac endothelial cells or in cardiac infiltrating macrophages 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ; interestingly, one case met ESC diagnostic criteria for a biopsy-proven but virus-negative and SARS-CoV-2 negative myocarditis [5] . In an international multicentre study, autopsies were performed in 21 patients with COVID-19 [20] and various forms of myocardial injury were observed.…”

Section: Introductionmentioning

confidence: 99%