TY - JOUR
T1 - Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis
AU - Ammirati, Enrico
AU - Lupi, Laura
AU - Palazzini, Matteo
AU - Hendren, Nicholas S.
AU - Grodin, Justin L.
AU - Cannistraci, Carlo V.
AU - Schmidt, Matthieu
AU - Hekimian, Guillaume
AU - Peretto, Giovanni
AU - Bochaton, Thomas
AU - Hayek, Ahmad
AU - Piriou, Nicolas
AU - Leonardi, Sergio
AU - Guida, Stefania
AU - Turco, Annalisa
AU - Sala, Simone
AU - Uribarri, Aitor
AU - Van De Heyning, Caroline M.
AU - Mapelli, Massimo
AU - Campodonico, Jeness
AU - Pedrotti, Patrizia
AU - Barrionuevo Sánchez, Maria Isabel
AU - Ariza Sole, Albert
AU - Marini, Marco
AU - Matassini, Maria Vittoria
AU - Vourc'H, Mickael
AU - Cannatà, Antonio
AU - Bromage, Daniel I.
AU - Briguglia, Daniele
AU - Salamanca, Jorge
AU - Diez-Villanueva, Pablo
AU - Lehtonen, Jukka
AU - Huang, Florent
AU - Russel, Stéphanie
AU - Soriano, Francesco
AU - Turrini, Fabrizio
AU - Cipriani, Manlio
AU - Bramerio, Manuela
AU - Di Pasquale, Mattia
AU - Grosu, Aurelia
AU - Senni, Michele
AU - Farina, Davide
AU - Agostoni, Piergiuseppe
AU - Rizzo, Stefania
AU - De Gaspari, Monica
AU - Marzo, Francesca
AU - Duran, Jason M.
AU - Adler, Eric D.
AU - Giannattasio, Cristina
AU - Basso, Cristina
AU - McDonagh, Theresa
AU - Kerneis, Mathieu
AU - Combes, Alain
AU - Camici, Paolo G.
AU - De Lemos, James A.
AU - Metra, Marco
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/4/12
Y1 - 2022/4/12
N2 - Background: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19-associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. Methods: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19-associated AM. Results: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). Conclusions: AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
AB - Background: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19-associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. Methods: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19-associated AM. Results: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). Conclusions: AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
KW - COVID-2019
KW - MRI
KW - MRI
KW - SARS-CoV-2
KW - cardiac
KW - myocarditis
KW - outcome
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UR - http://www.scopus.com/inward/citedby.url?scp=85127990196&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.121.056817
DO - 10.1161/CIRCULATIONAHA.121.056817
M3 - Article
C2 - 35404682
AN - SCOPUS:85127990196
SN - 0009-7322
VL - 145
SP - 1123
EP - 1139
JO - Circulation
JF - Circulation
IS - 15
ER -