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Research Article Open access CC BY 4.0

Myocarditis during SARS-CoV-2 Infection: A Series of 15 Cases

A. Benhlima, I. Bouzekraoui, A. Taj, A. Bouchaala, H. Elhamzaoui, M. Alilou

Asian Journal of Medicine and Health · pp. 85–94 · Published 23 Jun 2023

10.9734/ajmah/2023/v21i9861

Abstract

COVID-19 is a global health problem responsible for significant morbidity and mortality and a major socioeconomic impact. While the major manifestation is respirator with a risk of acute respiratory distress syndrome, several extrapulmonary aspects, particularly cardiovascular, have emerged over time. The aim of this work is to study the clinical, biological, radiological, therapeutic, and evolutionary characteristics of acute myocarditis associated with SARS-CoV-2 infection in comparison to data from the literature. This is a prospective cohort study conducted at the Ibn Sina University Hospital in Rabat over a period of 9 months (from January 1, 2021, to September 30, 2021) and included patients hospitalized in different departments managing COVID-19 and diagnosed with acute myocarditis confirmed by cardiac MRI. Fifteen patients were included during the study period. The average age of patients was 40 years old with a slight male predominance (sex ratio M/F-1.14). The average time between the onset of COVID-19 infection and the appearance of myocarditis symptoms was 17 days. The symptoms were mainly dominated by chest pain (40% of cases), unexplained cardiogenic shock (40% of cases), and palpitations (20% of cases). ECG revealed diffuse repolarization abnormalities in more than half of the cases (53%) and supraventricular tachycardia (27%). The inflammatory markers were significantly disturbed (CRP = 102 +/-47.30 mg/L and ferritin - 510 +/-336.45 ng/mL). Troponin I was elevated with myocarditis kinetics in all patients. Cardiac MRI showed T2 hypersignal corresponding to edema with early and late subepicardial enhancement, mainly located at the level of the left ventricular lateral wall. The evolution was marked by the occurrence of death in 5 patients (33.33%) in the days following hospitalization for cardiogenic shock and dilated cardiomyopathy in only one case (6.67%). It was favourable for the rest of the patients (60%). The results of this study have highlighted several characteristics of myocarditis associated with SARS-CoV-2. Firstly, there is a delayed interval between virus infection and the onset of cardiac symptoms. Additionally, the kinetics of myocardial injury markers are distinct, and there is significant disruption of inflammatory markers at the time of diagnosis. Moreover, fulminant forms of myocarditis are associated with a reserved prognosis and high mortality. Furthermore, the study emphasizes the crucial importance of cardiac MRI availability for confirming the diagnosis in the absence of histological evidence from endomyocardial biopsy.

Myocarditis SARS-CoV-2 COVID-19 anti-COVID treatment anti-COVID vaccination

References (26)

  1. 1 La certeza de lo impredecible: Cultura Educación y Sociedad en tiempos de COVID19
  2. 2 Clinical and immunological features of severe and moderate coronavirus disease 2019 [DOI]
  3. 3 Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China [DOI]
  4. 4 Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) [DOI]
  5. 5 Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases [DOI]
  6. 6 Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19) [DOI]
  7. 7 Incidence, Causes, and Outcomes of Dilated Cardiomyopathy in Children [DOI]
  8. 8 Myocardial Localization of Coronavirus in COVID-19 Cardiogenic Shock [DOI]
  9. 9 SARS‐coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS [DOI]
  10. 10 Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging [DOI]
  11. 11 Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019 [DOI]
  12. 12 How to Interpret Elevated Cardiac Troponin Levels [DOI]
  13. 13 COVID-19 and Myocarditis: What Do We Know So Far? [DOI]
  14. 14 Epidemiological Impact of Myocarditis [DOI]
  15. 15 Factors associated with myocardial SARS-CoV-2 infection, myocarditis, and cardiac inflammation in patients with COVID-19 [DOI]
  16. 16 Cardiac Troponin Thresholds and Kinetics to Differentiate Myocardial Injury and Myocardial Infarction [DOI]
  17. 17 Sudden cardiac death caused by myocarditis in persons aged 1–49 years: a nationwide study of 14 294 deaths in Denmark [DOI]
  18. 18 Cardiac Magnetic Resonance Characterization of Myocarditis-Like Acute Cardiac Syndrome in COVID-19 [DOI]
  19. 19 Delayed-onset myocarditis following COVID-19 [DOI]
  20. 20 COVID-19 myocarditis and prospective heart failure burden [DOI]
  21. 21 Update on myocarditis – what we know so far and where we may be heading [DOI]
  22. 22 Cardiac MRI in Suspected Acute COVID-19 Myocarditis [DOI]
  23. 23 Dilated Cardiomyopathy Risk in Patients with Coronavirus Disease 2019: How to Identify and Characterise it Early? [DOI]
  24. 24 Case Report: Dilated Cardiomyopathy in a Newborn, a Potential Association With SARS-COV-2 [DOI]
  25. 25 European Journal of Clinical Investigation [DOI]
  26. 26 COVID-19: Myocardial Injury in Survivors [DOI]

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