Myocarditis associated with COVID-19 infection

Prof.  Isayeva G. S.

Government Institution “L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine” 

The article summarizes current data on the problem of myocarditis in patients with COVID-19 infection. Features of pathogenesis, risk factors, features of clinical manifestations and treatment of myocarditis are highlighted. Special attention is paid to post-vaccination myocarditis. Heterogeneity of clinical manifestations and severity of myocarditis have been demonstrated. Possible approaches and indications for anti-inflammatory therapy are considered. Management of patients with severe myocarditis requires the involvement of physicians of various specialties and decision-making when prescribing anti-inflammatory therapy with a cardiologist. 

 Key words: COVID-19 infection, myocarditis, glucocorticosteroids. 

https://doi.org/10.15407/internalmed2022.01.064  

Download.PDF (ukr) 

For cite: 

Ісаєва, Г.С. Міокардит, асоційований із інфекцією COVID-19 // Східноєвропейський журнал внутрішньої та сімейної медицини. – 2022. – № 1. – С. 64-68. doi:  10.15407/internalmed2022.01.064   

Isaeva GS. Miokardyt, asotsiiovanyi iz infektsiieiu COVID-19. [Myocarditis associated with COVID-19 infection]. Shidnoevr. z. vnutr. simejnoi med. 2022;1:64-68. Ukrainian. doi: 10.15407/internalmed2022.01.064   

References: 

  1. Garg P, Arora U, Kumar A, Wig N. The “post‐COVID” syndrome: How deep is the damage?. Journal of Medical Virology. 2020;93(2):673-674. http://dx.doi.org/10.1002/jmv.26465
  2. Zeng J, Liu Y, Yuan J, Wang F, Wu W, Li J, Wang L, Gao H, Wang Y, Dong C, Li Y, Xie X, Feng C, Liu L. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020;48(5):773-777. http://dx.doi.org/10.1007/s15010-020-01424-5
  3. Ammirati E, Frigerio M, Adler E, Basso C, Birnie D, Brambatti M, Friedrich M, Klingel K, Lehtonen J, Moslehi J, Pedrotti P, Rimoldi O, Schultheiss H, Tschöpe C, Cooper L, Camici P. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy. Circulation: Heart Failure. 2020;13(11):. http://dx.doi.org/10.1161/circheartfailure.120.007405
  4. Tymińska A, Ozierański K, Caforio A, Marcolongo R, Marchel M, Kapłon-Cieślicka A, Baritussio A, Filipiak K, Opolski G, Grabowski M. Myocarditis and inflammatory cardiomyopathy in 2021 – an update. Polish Archives of Internal Medicine. 2021;:. http://dx.doi.org/10.20452/pamw.16010
  5. Metkus T, Sokoll L, Barth A, Czarny M, Hays A, Lowenstein C, Michos E, Nolley E, Post W, Resar J, Thiemann D, Trost J, Hasan R. Myocardial Injury in Severe COVID-19 Compared With Non–COVID-19 Acute Respiratory Distress Syndrome. Circulation. 2021;143(6):553-565. http://dx.doi.org/10.1161/circulationaha.120.050543
  6. Ali L, Mohammed I, Janjua I, Naeem M, Adeli G, Elalamy O, Alhatou M, Akhtar N, Canibano B, Iqrar A. Acute Myocardial Injury and Rhabdomyolysis in COVID-19 Patients: Incidence and Mortality. Cureus. 2021;:. http://dx.doi.org/10.7759/cureus.18899
  7. Navaratnarajah C, Pease D, Halfmann P, Taye B, Barkhymer A, Howell K, Charlesworth J, Christensen T, Kawaoka Y, Cattaneo R, Schneider J. Highly efficient SARS-CoV-2 infection of human cardiomyocytes: spike protein-mediated cell fusion and its inhibition. 2021;:. http://dx.doi.org/10.1101/2021.07.30.454437
  8. Bojkova D, Wagner J, Shumliakivska M, Aslan G, Saleem U, Hansen A, Luxán G, Günther S, Pham M, Krishnan J, Harter P, Ermel U, Frangakis A, Milting H, Zeiher A, Klingel K, Cinatl J, Dendorfer A, Eschenhagen T, Tschöpe C, Ciesek S, Dimmeler S. SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes. Cardiovascular Research. 2020;116(14):2207-2215. http://dx.doi.org/10.1093/cvr/cvaa267
  9. Bulfamante G, Perrucci G, Falleni M, Sommariva E, Tosi D, Martinelli C, Songia P, Poggio P, Carugo S, Pompilio G. Evidence of SARS-CoV-2 Transcriptional Activity in Cardiomyocytes of COVID-19 Patients without Clinical Signs of Cardiac Involvement. Biomedicines. 2020;8(12):626. http://dx.doi.org/10.3390/biomedicines8120626
  10. Kaya H, Asoglu R, Afsin A, Tibilli H, Kurt E, Kafadar S, Gulacti U, Kafadar H. The evaluation of myocardial performance index in patients with COVID-19: An echocardiographic follow-up study. European Heart Journal – Cardiovascular Imaging. 2021;22(Supplement_1):. http://dx.doi.org/10.1093/ehjci/jeaa356.100
  11. Agdamag A, Edmiston J, Charpentier V, Chowdhury M, Fraser M, Maharaj V, Francis G, Alexy T. Update on COVID-19 Myocarditis. Medicina. 2020;56(12):678. http://dx.doi.org/10.3390/medicina56120678
  12. Shchendrygina A, Nagel E, Puntmann V, Valbuena-Lopez S. COVID-19 myocarditis and prospective heart failure burden. Expert Review of Cardiovascular Therapy. 2020;19(1):5-14. http://dx.doi.org/10.1080/14779072.2021.1844005
  13. Kamal M, Abo Omirah M, Hussein A, Saeed H. Assessment and characterisation of post‐COVID‐19 manifestations. International Journal of Clinical Practice. 2020;75(3):. http://dx.doi.org/10.1111/ijcp.13746
  14. Han H, Yang L, Liu R, Liu F, Wu K, Li J, Liu X, Zhu C. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clinical Chemistry and Laboratory Medicine (CCLM). 2020;58(7):1116-1120. http://dx.doi.org/10.1515/cclm-2020-0188
  15. Guzik T, Mohiddin S, Dimarco A, Patel V, Savvatis K, Marelli-Berg F, Madhur M, Tomaszewski M, Maffia P, D’Acquisto F, Nicklin S, Marian A, Nosalski R, Murray E, Guzik B, Berry C, Touyz R, Kreutz R, Wang D, Bhella D, Sagliocco O, Crea F, Thomson E, McInnes I. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovascular Research. 2020;116(10):1666-1687. http://dx.doi.org/10.1093/cvr/cvaa106
  16. Sandoval Y, Januzzi J, Jaffe A. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19. Journal of the American College of Cardiology. 2020;76(10):1244-1258. http://dx.doi.org/10.1016/j.jacc.2020.06.068
  17. Peretto G, Sala S, Rizzo S, De Luca G, Campochiaro C, Sartorelli S, Benedetti G, Palmisano A, Esposito A, Tresoldi M, Thiene G, Basso C, Della Bella P. Arrhythmias in myocarditis: State of the art. Heart Rhythm. 2019;16(5):793-801. http://dx.doi.org/10.1016/j.hrthm.2018.11.024
  18. Lozano Gómez H, Pascual Bielsa A, Arche Banzo M. Fulminant myocarditis and cardiogenic shock during SARS-CoV-2 infection. Medicina Clínica (English Edition). 2020;155(10):463-464. http://dx.doi.org/10.1016/j.medcle.2020.07.012
  19. Irabien-Ortiz Á, Carreras-Mora J, Sionis A, Pàmies J, Montiel J, Tauron M. Miocarditis fulminante por COVID-19. Revista Española de Cardiología. 2020;73(6):503-504. http://dx.doi.org/10.1016/j.recesp.2020.04.001
  20. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang X, Lu Z. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiology. 2020;5(7):811. http://dx.doi.org/10.1001/jamacardio.2020.1017
  21. Onderko L, Starobin B, Riviere A, Hohl P, Phillips C, Morgan R, Welsh A, Francis S, Afari M. Myocarditis in the Setting of Recent COVID-19 Vaccination. Case Reports in Cardiology. 2021;2021:1-5. http://dx.doi.org/10.1155/2021/6806500
  22. Diaz G, Parsons G, Gering S, Meier A, Hutchinson I, Robicsek A. Myocarditis and Pericarditis After Vaccination for COVID-19. JAMA. 2021;326(12):1210. http://dx.doi.org/10.1001/jama.2021.13443
  23. Al‐Ali D, Elshafeey A, Mushannen M, Kawas H, Shafiq A, Mhaimeed N, Mhaimeed O, Mhaimeed N, Zeghlache R, Salameh M, Paul P, Homssi M, Mohammed I, Narangoli A, Yagan L, Khanjar B, Laws S, Elshazly M, Zakaria D. Cardiovascular and haematological events post COVID‐19 vaccination: A systematic review. Journal of Cellular and Molecular Medicine. 2021;26(3):636-653. http://dx.doi.org/10.1111/jcmm.17137
  24. Pepe S, Gregory A, Denniss A. Myocarditis, Pericarditis and Cardiomyopathy After COVID-19 Vaccination. Heart, Lung and Circulation. 2021;30(10):1425-1429. http://dx.doi.org/10.1016/j.hlc.2021.07.011
  25. Mason J, O’Connell J, Herskowitz A, Rose N, McManus B, Billingham M, Moon T. A Clinical Trial of Immunosuppressive Therapy for Myocarditis. New England Journal of Medicine. 1995;333(5):269-275. http://dx.doi.org/10.1056/nejm199508033330501
  26. Chen H, Wang W, Wu S, Liu J. Corticosteroids for viral myocarditis. Cochrane Database of Systematic Reviews. 2013;2021(4):. http://dx.doi.org/10.1002/14651858.cd004471.pub3
  27. Caldeira D, Lopes L, Vaz-Carneiro A, Costa J. Cochrane Corner: Corticosteroids for viral myocarditis. Revista Portuguesa de Cardiologia (English Edition). 2015;34(1):65-67. http://dx.doi.org/10.1016/j.repce.2014.08.007
  28. Kow C, Hasan S. Glucocorticoid versus immunoglobulin in the treatment of COVID-19-associated fulminant myocarditis. Infection. 2020;48(5):805-806. http://dx.doi.org/10.1007/s15010-020-01441-4
  29. Coyle J, Igbinomwanhia E, Sanchez-Nadales A, Danciu S, Chu C, Shah N. A Recovered Case of COVID-19 Myocarditis and ARDS Treated With Corticosteroids, Tocilizumab, and Experimental AT-001. JACC: Case Reports. 2020;2(9):1331-1336. http://dx.doi.org/10.1016/j.jaccas.2020.04.025
  30. Garot J, Amour J, Pezel T, Dermoch F, Messadaa K, Felten M, Raymond V, Baubillier E, Sanguineti F, Garot P. SARS-CoV-2 Fulminant Myocarditis. JACC: Case Reports. 2020;2(9):1342-1346. http://dx.doi.org/10.1016/j.jaccas.2020.05.060
  31. Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. European Heart Journal. 2020;42(2):206-206. http://dx.doi.org/10.1093/eurheartj/ehaa190
  32. Huang X, Sun Y, Su G, Li Y, Shuai X. Intravenous Immunoglobulin Therapy for Acute Myocarditis in Children and Adults. International Heart Journal. 2019;60(2):359-365. http://dx.doi.org/10.1536/ihj.18-299