Pericarditis after SARS-CoV-2 Infection: Another Pebble in the Mosaic of Long COVID?

Carubbi, Francesco; Alunno, Alessia; Leone, Silvia; Gregorio, N. Di; Mancini, Bernardina; Pinto, Rita Del; Cicogna, Sabrina; Grassi, Davide; Ferri, Claudio

doi:10.3390/v13101997

Cited by 23 publications

(27 citation statements)

References 41 publications

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“…The main pathological features of COVID-19 mediated myocardial damage in convalescing patients often differ from classical viral-mediated myocarditis particularly in subjects with less severe disease ( 73 ) ( Figure 1 ). Characteristics of acute phase COVID-19 like pericarditis are infrequently observed ( 74 ). Thus, the adoption of the Lake Louise criteria applied extensively for myocarditis definition ( 38 , 39 ), may not always be suitable in the setting of convalescent COVID-19.…”

Section: Discussionmentioning

confidence: 99%

The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients

Borlotti¹,

Thomaides-Brears²,

Georgiopoulos

et al. 2022

Front. Cardiovasc. Med.

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In COVID-19 the development of severe viral pneumonia that is coupled with systemic inflammatory response triggers multi-organ failure and is of major concern. Cardiac involvement occurs in nearly 60% of patients with pre-existing cardiovascular conditions and heralds worse clinical outcome. Diagnoses carried out in the acute phase of COVID-19 rely upon increased levels of circulating cardiac injury biomarkers and transthoracic echocardiography. These diagnostics, however, were unable to pinpoint the mechanisms of cardiac injury in COVID-19 patients. Identifying the main features of cardiac injury remains an urgent yet unmet need in cardiology, given the potential clinical consequences. Cardiovascular magnetic resonance (CMR) provides an unparalleled opportunity to gain a deeper insight into myocardial injury given its unique ability to interrogate the properties of myocardial tissue. This endeavor is particularly important in convalescent COVID-19 patients as many continue to experience chest pain, palpitations, dyspnea and exertional fatigue, six or more months after the acute illness. This review will provide a critical appraisal of research on cardiovascular damage in convalescent adult COVID-19 patients with an emphasis on the use of CMR and its value to our understanding of organ damage.

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Section: Discussionmentioning

confidence: 99%

The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients

Borlotti¹,

Thomaides-Brears²,

Georgiopoulos

et al. 2022

Front. Cardiovasc. Med.

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“…It is notable that although some authors have reported major cardiac abnormalities after recovery of COVID-19 infection, such as depressed LVEF [ 45 ], pericarditis, and pericardial effusion [ 46 , 47 ], these findings have not been detected in most majority of publications to date [ 5 , 36 – 42 ]. A possible explanation for these findings is that these are predominantly case reports or case series with small sample size.…”

Section: Discussionmentioning

confidence: 99%

Abnormal echocardiographic findings after COVID-19 infection: a multicenter registry

Picco¹,

Lépori

Galello³

et al. 2022

Int J Cardiovasc Imaging

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The Coronavirus Disease 2019 (COVID-19) pandemic has transformed health systems worldwide. There is conflicting data regarding the degree of cardiovascular involvement following infection. A registry was designed to evaluate the prevalence of echocardiographic abnormalities in adults recovered from COVID-19. We prospectively evaluated 595 participants (mean age 45.5 ± 14.9 years; 50.8% female) from 10 institutions in Argentina and Brazil. Median time between infection and evaluation was two months, and 82.5% of participants were not hospitalized for their infection. Echocardiographic studies were conducted with General Electric equipment; 2DE imaging and global longitudinal strain (GLS) of both ventricles were performed. A total of 61.7% of the participants denied relevant cardiovascular history and 41.8% had prolonged symptoms after resolution of COVID-19 infection. Mean left ventricular ejection fraction (LVEF) was 61.0 ± 5.5% overall. In patients without prior comorbidities, 8.2% had some echocardiographic abnormality: 5.7% had reduced GLS, 3.0% had a LVEF below normal range, and 1.1% had wall motion abnormalities. The right ventricle (RV) was dilated in 1.6% of participants, 3.1% had a reduced GLS, and 0.27% had reduced RV function. Mild pericardial effusion was observed in 0.82% of participants. Male patients were more likely to have new echocardiographic abnormalities (OR 2.82, p = 0.002). Time elapsed since infection resolution (p = 0.245), presence of symptoms (p = 0.927), or history of hospitalization during infection (p = 0.671) did not have any correlation with echocardiographic abnormalities. Cardiovascular abnormalities after COVID-19 infection are rare and usually mild, especially following mild infection, being a low GLS of left and right ventricle, the most common ones in our registry. Post COVID cardiac abnormalities may be more frequent among males. Supplementary Information The online version contains supplementary material available at 10.1007/s10554-022-02706-9.

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“… 13 PCS-related pericardial effusion alone was unlikely to explain her chest pain, dyspnea, and palpitations. 14 …”

Section: Discussionmentioning

confidence: 99%

Acupuncture in Multidisciplinary Treatment for Post-COVID-19 Syndrome

Trager

Brewka

Kaiser

et al. 2022

Medical Acupuncture

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Background: Post-COVID syndrome (PCS) is a complex, multisystem illness that may follow SARS-CoV-2/COVID-19 infection. As there is limited evidence for individual therapies and no singular treatment for PCS, guidelines endorse a multidisciplinary approach. This is a case report of a patient with PCS benefiting from a comprehensive approach including acupuncture with symptom-titrated physical activity (STPA). Case: A 50-year-old woman presented from a Long-COVID Clinic referral to an outpatient hospital-affiliated acupuncturist. She had 8 months of fatigue, anosmia, chest pressure, palpitations, and other symptoms following mild assay-confirmed COVID-19. Prior/concurrent medical testing revealed multisystem-inflammatory involvement (pericardial effusion, thyroid dysfunction, and elevated d -dimers). Cardiology/pulmonology cleared the patient for exercise to tolerance considering that serious pathology was absent. The acupuncturist's Traditional Chinese Medicine impression was of Qi Deficiency of the Heart, Lung, Spleen, and Kidney. This patient received 7 sessions of scalp, auricular, and body acupuncture. Physical-therapist (PT)-led STPA began 1-week post-acupuncture, involving 6 30-minute exercise sessions while monitoring her heart rate, with as-needed rest. Results: The patient's chest pressure and palpitations resolved after 1 acupuncture treatment. With 6 additional treatments, spanning 9 weeks, overlapping with PT-led SPTA, she recovered completely and resumed her normal exercise. Conclusions: Acupuncture appeared to facilitate PCS recovery. However, the independent effects of acupuncture are less clear, given the concurrent STPA/exercise therapy, and should be explored using large study designs. Acupuncture is an attractive potential PCS therapy, considering its holistic approach and that it may be added to a multidisciplinary, guideline-concordant regimen.

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Pericarditis after SARS-CoV-2 Infection: Another Pebble in the Mosaic of Long COVID?

Cited by 23 publications

References 41 publications

The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients

The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients

Abnormal echocardiographic findings after COVID-19 infection: a multicenter registry

Acupuncture in Multidisciplinary Treatment for Post-COVID-19 Syndrome

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