Pericardial Involvement in Patients Hospitalized With COVID‐19: Prevalence, Associates, and Clinical Implications

Ghantous, Eihab; Szekely, Yishay; Lichter, Yael; Levi, Erez; Taieb, Philippe; Banai, Ariel; Sapir, Orly; Granot, Yoav; Lupu, Lior; Hochstadt, Aviram; Merdler, Ilan; Borohovitz, Ariel; Sadon, Sapir; Ingbir, Merav; Laufer‐Perl, Michal; Banai, Shmuel; Topilsky, Yan

doi:10.1161/jaha.121.024363

Cited by 16 publications

(17 citation statements)

References 38 publications

(52 reference statements)

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“…Ghantous et al reported that from 750 evaluated patients, 75 presented pericardial effusion and only 17 patients were diagnosed with acute pericarditis. None of them evolved into cardiac tamponade [ 8 ]. Moreover, most of the available reported cases are associated with the early course of the disease and concomitant positive SARS-CoV-2 RT-PCR detection [ 3 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…COVID-19 extrapulmonary lesions, including pleural effusion, were mostly associated with a severe course of the disease, worse pulmonary disease, and right ventricle dysfunction [ 8 , 10 ]. Brito et al also reported that mild or moderate forms of COVID-19 may also be associated with pericardial involvement, including pericardial effusion.…”

Section: Discussionmentioning

confidence: 99%

“…Although pericardial effusion is relatively prevalent, acute pericarditis and cardiac tamponade are rarely reported [ 8 ]. Cardiac tamponade emergence is reported to be variable according to the initial SARS-CoV-2 infection [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Hemorrhagic Cardiac Tamponade—An Unusual Threat in the COVID-19 Recovery Phase

et al. 2022

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Cardiac tamponade is a rare presentation in patients with COVID-19, which may be induced by the associated exacerbated inflammatory response. The onset of cardiac tamponade may be concomitant with the acute phase of the disease or may develop subsequently as a new health condition secondary to the disease. We report four cases of cardiac tamponade that occurred late after the acute phase of the disease. One of them may be considered a post-acute complication of the disease, and three of them may be classified as a new health condition induced by COVID-19. Only two cases had a history of severe respiratory distress due to COVID-19. In all four cases, pericardiocentesis was imposed, and surprisingly, in every case, hemorrhagic fluid was evacuated. In this case, series, immune-mediated etiology is supported by histopathological results, where the main identified feature was fibrous pericarditis with inflammatory infiltrate. Only one patient included in this report died, and three of them were discharged after anti-inflammatory treatment was initiated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hemorrhagic Cardiac Tamponade—An Unusual Threat in the COVID-19 Recovery Phase

et al. 2022

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“…In patients infected with the wild‐type strain, the marked alterations in RV afterload, LV preload, and possible myocardial injury resulted in worsening LV/RV functional parameters in patients with severe/critical disease. 5 , 6 , 23 , 24 However, in the Omicron cohort, with lesser alteration in loading conditions, possibly the increase in adrenergic tone “tilted” the functional LV/RV parameters in the opposite direction. Furthermore, another possible hypothesis is that in patients with Omicron infection, RV/LV dysfunction are mostly related to background disease and less to the acute infection.…”

Section: Discussionmentioning

confidence: 97%

Cardiologic Manifestations in Omicron‐Type Versus Wild‐Type COVID‐19: A Systematic Echocardiographic Study

Ghantous

Shetrit

Hochstadt

et al. 2023

JAHA

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Background Information about the cardiac manifestations of the Omicron variant of COVID‐19 is limited. We performed a systematic prospective echocardiographic evaluation of consecutive patients hospitalized with the Omicron variant of COVID‐19 infection and compared them with similarly recruited patients were propensity matched with the wild‐type variant. Methods and Results A total of 162 consecutive patients hospitalized with Omicron COVID‐19 underwent complete echocardiographic evaluation within 24 hours of admission and were compared with propensity‐matched patients with the wild‐type variant (148 pairs). Echocardiography included left ventricular (LV) systolic and diastolic, right ventricular (RV), strain, and hemodynamic assessment. Echocardiographic parameters during acute infection were compared with historic exams in 62 patients with the Omicron variant and 19 patients with the wild‐type variant who had a previous exam within 1 year. Of the patients, 85 (53%) had a normal echocardiogram. The most common cardiac pathology was RV dilatation and dysfunction (33%), followed by elevated LV filling pressure (E/e′ ≥14, 29%) and LV systolic dysfunction (ejection fraction <50%, 10%). Compared with the matched wild‐type cohort, patients with Omicron had smaller RV end‐systolic areas (9.3±4 versus 12.3±4 cm 2 ; P =0.0003), improved RV function (RV fractional‐area change, 53.2%±10% versus 39.7%±13% [ P <0.0001]; RV S′, 12.0±3 versus 10.7±3 cm/s [ P =0.001]), and higher stroke volume index (35.6 versus 32.5 mL/m 2 ; P =0.004), all possibly related to lower mean pulmonary pressure (34.6±12 versus 41.1±14 mm Hg; P =0.0001) and the pulmonary vascular resistance index ( P =0.0003). LV systolic or diastolic parameters were mostly similar to the wild‐type variant‐matched cohort apart from larger LV size. However, in patients who had a previous echocardiographic exam, these LV abnormalities were recorded before acute Omicron infection, but not in the wild‐type cohort. Numerous echocardiographic parameters were associated with higher in‐hospital mortality (LV ejection fraction, stroke volume index, E/e′, RV S′). Conclusions In patients with Omicron, RV function is impaired to a lower extent compared with the wild‐type variant, possibly related to the attenuated pulmonary parenchymal and/or vascular disease. LV systolic and diastolic abnormalities are as common as in the wild‐type variant but were usually recorded before acute infection and probably reflect background cardiac morbidity. Numerous LV and RV abnormalities are associated with adverse outcome in patients with Omicron.

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“…Detection of SARS-CoV-2 in effusions support direct pericardial invasion, but the exact mechanism remains unclear. Furthermore, the limited number of publications reporting the detection of SARS-CoV-2 in pericardial fluid may be due to the small proportion of individuals who undergo pericardial drainage among COVID-19 patients with pericardial effusion [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report

Yanes¹,

Malijan

Escora-Garcia³

et al. 2022

Trop Med Health

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Background Pericardial effusion is a late manifestation of HIV more commonly observed in individuals with depressed CD4 counts. Although Mycobacterium tuberculosis remains to be one of the most frequently identified pathogens in the pericardial fluid among people living with HIV, less commonly described etiologies include SARS-CoV-2 that causes coronavirus disease and human herpesvirus-8 which is associated with Kaposi sarcoma. Isolation of more than one pathogen in normally sterile sites remains challenging and rare. We report the first documentation of both SARS-CoV-2 and HHV-8 in the pericardial fluid. Case presentation We present the case of a young man in his 20s with a recent history of clinically diagnosed pulmonary tuberculosis who was admitted for progressive dyspnea and cough. He had multiple violaceous cutaneous lesions on the face, neck, and trunk and diffused lymphadenopathies. He tested positive for SARS-CoV-2 on admission. The patient was clinically diagnosed with pneumonia, Kaposi sarcoma, and HIV/AIDS. Empiric broad spectrum antimicrobial regimen was subsequently initiated. HIV with low CD4 count was confirmed during hospitalization. Echocardiography revealed a large pericardial effusion, in impending cardiac tamponade. Frond-like fibrin strands, extending to the parietal pericardium, were also observed. Pericardiostomy yielded hemorrhagic, exudative effusion with lymphocytic predominance. SARS-CoV-2 and HHV-8 were detected in the pericardial fluid, and bacterial, fungal, and tuberculous studies were negative. The patient had clinical improvement after pericardial drainage. However, despite our best clinical care, he developed a nosocomial infection leading to clinical deterioration and death. Conclusion Detection of SARS-CoV-2 and HHV-8 in the pericardial fluid is rare, and interpretation of their significance in clinical care is challenging. However, coronavirus disease and Kaposi sarcoma must be considered and adequately addressed in immunocompromised adults presenting with large pericardial effusion.

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Pericardial Involvement in Patients Hospitalized With COVID‐19: Prevalence, Associates, and Clinical Implications

Cited by 16 publications

References 38 publications

Hemorrhagic Cardiac Tamponade—An Unusual Threat in the COVID-19 Recovery Phase

Hemorrhagic Cardiac Tamponade—An Unusual Threat in the COVID-19 Recovery Phase

Cardiologic Manifestations in Omicron‐Type Versus Wild‐Type COVID‐19: A Systematic Echocardiographic Study

Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report

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