Pericarditis and myocarditis long after SARS-CoV-2 infection: a cross-sectional descriptive study in health-care workers

Abstract

Background: Cardiac sequelae of past SARS-CoV-2 infection are still poorly documented. We conducted a cross-sectional study in health-care workers to report evidence of pericarditis and myocarditis after SARS-CoV-2 infection. Methods We studied 139 health-care workers with confirmed past SARS-CoV-2 infection (103 diagnosed by RT-PCR and 36 by serology). Participants underwent clinical assessment, electrocardiography, laboratory tests including immune cell profiling and cardiac magnetic resonance (CMR) imaging. Pericarditis was diagnosed when classical criteria were present, and the diagnosis of myocarditis was based on the updated CMR Lake-Louise-Criteria. Results: Median age was 52 years (IQR 41-57), 100 (72%) were women, and 23 (16%) were previously hospitalized for Covid-19 pneumonia. At examination (10.4 [9.3-11.0] weeks after infection-like symptoms), all participants presented hemodynamic stability. Chest pain, dyspnoea or palpitations were observed in 58 (42%) participants; electrocardiographic abnormalities in 69 (50%); NT-pro-BNP was elevated in 11 (8%); troponin in 1 (1%); and CMR abnormalities in 104 (75%). Isolated pericarditis was diagnosed in 4 (3%) participants, myopericarditis in 15 (11%) and isolated myocarditis in 36 (26%). Participants diagnosed by RT-PCR were more likely to still present symptoms than participants diagnosed by serology (73 [71%] vs 18 [50%]; p=0.027); nonetheless, the prevalence of pericarditis or myocarditis was high in both groups (44 [43%] vs 11 [31%]; p=0.238). Most participants (101 [73%]) showed altered immune cell counts in blood, particularly decreased eosinophil (37 [27%]; p<0.001) and increased CD4-CD8-/loT alpha beta-cell numbers (24 [17%]; p<0.001). Pericarditis was associated with elevated CD4-CD8-/loT alpha beta-cell numbers (p=0.011), while participants diagnosed with myopericarditis or myocarditis had lower (p<0.05) plasmacytoid dendritic cell, NK-cell and plasma cell counts and lower anti-SARS-CoV-2-IgG antibody levels (p=0.027). Conclusions: Pericarditis and myocarditis with clinical stability are frequent long after SARS-CoV-2 infection, even in presently asymptomatic subjects. These observations will probably apply to the general population infected and may indicate that cardiac sequelae might occur late in association with an altered (delayed) innate and adaptative immune response.

COVID-19 sequelae in adults aged less than 50 years: A systematic review

“…References classified into the cardiovascular and hematological category included two prospective cohort studies, one cross-sectional study and one case report [ [25] , [26] , [27] , [28] ].…”

“…Time to follow-up examination varied from 11 days after quarantine to approximatively three months post-diagnosis. Three studies performed cardiac magnetic resonance imaging and observed evidence of peri-, myoperi- and myocarditis in 3-26% of the participants [ [25] , [26] , [27] ]. One study showed altered immune cell counts 9-11 weeks after symptom onset [ 25 ], while a case report described isolated thrombocytopenia in a patient approximatively one month after symptom onset [ 28 ].…”

“…According to the studies found in this review, cardiac damage might be a significant long-term sequela. Myocarditis, perimyocarditis and pericarditis were diagnosed as late as 11 weeks after symptom of infection onset [ 25 ]. Rajpal et al showed that cardiac consequences were also pronounced in younger athletes [ 27 ].…”

Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations

“…A preprint, also looking at health-care workers >2 months after disease resolution suggested rates of myocarditis, myopericarditis, and pericarditis at 26%, 11% and 4% respectively. Both studies relied on cardiac MRI and hsTnT for these diagnoses [7] .…”

From Editor-in-Chief: Has everything changed during pandemic: peer-review, science, clinical practices and education, CV diseases?

“…Recent clinical studies have shown that myocardial injury is encounted more often than it was thought and about 40% of patients with COVID-19, not only critically ill, had increased troponine values (14). Cardiac magnetic resonance studies demonstrated that 78% of patients after recovery from COVID-19 had signs of inflammation and myocardial oedema (15) or develop asymptomatic myopericarditis late after disease (16). Autopsy studies showed presence of virus genome in myocardium (17).…”