Prevalence, Characteristics, and Outcomes of COVID-19–Associated Acute Myocarditis-Reference-Cited by-同舟云学术

Prevalence, Characteristics, and Outcomes of COVID-19–Associated Acute Myocarditis

Published:2022-04-12 Issue:15 Volume:145 Page:1123-1139
ISSN:0009-7322
Container-title:Circulation
language:en
Short-container-title:Circulation

Author:

Ammirati Enrico¹^ORCID,Lupi Laura²,Palazzini Matteo¹,Hendren Nicholas S.³^ORCID,Grodin Justin L.³^ORCID,Cannistraci Carlo V.⁴⁵,Schmidt Matthieu⁶,Hekimian Guillaume⁶,Peretto Giovanni⁷^ORCID,Bochaton Thomas⁸^ORCID,Hayek Ahmad⁸,Piriou Nicolas⁹^ORCID,Leonardi Sergio¹⁰,Guida Stefania¹⁰^ORCID,Turco Annalisa¹⁰,Sala Simone⁷^ORCID,Uribarri Aitor¹¹¹²^ORCID,Van de Heyning Caroline M.¹³,Mapelli Massimo¹⁴¹⁵^ORCID,Campodonico Jeness¹⁴¹⁵^ORCID,Pedrotti Patrizia¹,Barrionuevo Sánchez Maria Isabel¹⁶,Ariza Sole Albert¹⁶,Marini Marco¹⁷,Matassini Maria Vittoria¹⁷,Vourc’h Mickael¹⁸¹⁹^ORCID,Cannatà Antonio²⁰²¹^ORCID,Bromage Daniel I.²⁰²¹^ORCID,Briguglia Daniele²²,Salamanca Jorge²³^ORCID,Diez-Villanueva Pablo²³,Lehtonen Jukka²⁴,Huang Florent²⁵^ORCID,Russel Stéphanie²⁵,Soriano Francesco¹,Turrini Fabrizio²⁶,Cipriani Manlio¹,Bramerio Manuela²⁷,Di Pasquale Mattia²^ORCID,Grosu Aurelia²⁸,Senni Michele²⁸,Farina Davide²⁹^ORCID,Agostoni Piergiuseppe¹⁴¹⁵^ORCID,Rizzo Stefania³⁰^ORCID,De Gaspari Monica³⁰^ORCID,Marzo Francesca³¹^ORCID,Duran Jason M.³²^ORCID,Adler Eric D.³²,Giannattasio Cristina¹³³,Basso Cristina³⁰^ORCID,McDonagh Theresa²⁰²¹,Kerneis Mathieu³⁴,Combes Alain⁶,Camici Paolo G.⁷^ORCID,de Lemos James A.³^ORCID,Metra Marco²^ORCID

Affiliation:

1. De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).

2. Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra).

3. Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.).

4. Center for Complex Network Intelligence, Tsinghua Laboratory of Brain and Intelligence, Department of Computer Science, Department of Biomedical Engineering, Tsinghua University, Beijing, China (C.V.C.).

5. Center for Systems Biology Dresden, Germany (C.V.C.).

6. Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive–Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié–Salpêtrière, France (M. Schmidt, G.H., A. Combes).

7. San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.).

8. Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.).

9. Université Nantes, CHU Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, l’Institut du Thorax, France (N.P.).

10. University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.).

11. Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain (A.U.).

12. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (A.U.).

13. Department of Cardiology, Antwerp University Hospital, and Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton Research Group, Antwerp University, Belgium (C.M.V.d.H.).

14. Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).

15. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.).

16. Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d’Investigació Biomèdica de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, L’Hospotalet del Llobregat, Barcelona, Spain (M.I.B.S., A.A.S.).

17. Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I–GM Lancisi–G Salesi, Ancona, Italy (M. Marini, M.V.M.).

18. Department of Anesthesiology and Surgical Intensive Care, Hôpital Laennec, University Hospital of Nantes, France (M.V.).

19. School of Medicine, UPRES EA 3826, Thérapeutiques Cliniques et Expérimentales des Infections, IRS2 Nantes Biotech, France (M.V.).

20. School of Cardiovascular Medicine and Sciences, King’s College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).

21. Department of Cardiology, King’s College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.).

22. Mater Domini Humanitas Hospital, Castellanza, Italy (D.B.).

23. Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.).

24. Heart and Lung Center, Department of Cardiology, Helsinki University Hospital, Finland (J.L.).

25. Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel).

26. Ospedale Civile di Baggiovara, Modena, Italy (F.T.).

27. Department of Histopathology, Niguarda Hospital, Milano, Italy (M.B.).

28. Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni).

29. Institute of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (D.F.).

30. Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.).

31. Department of Cardiology, Infermi Hospital, Rimini, Italy (F.M.).

32. Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.).

33. Department of Health Sciences, University of Milano-Bicocca, Monza, Italy (C.G.).

34. Sorbonne Université, ACTION Study Group, Institut National de la Santé et de la Recherche Médicale UMRS1166, Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (M.K.).

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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