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

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  • Enrico Ammirati
    De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).
  • Laura Lupi
    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).
  • Matteo Palazzini
    De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).
  • Nicholas S. Hendren
    Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.).
  • Justin L. Grodin
    Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.).
  • Carlo V. Cannistraci
    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.).
  • Matthieu Schmidt
    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).
  • Guillaume Hekimian
    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).
  • Giovanni Peretto
    San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.).
  • Thomas Bochaton
    Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.).
  • Ahmad Hayek
    Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.).
  • Nicolas Piriou
    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.).
  • Sergio Leonardi
    University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.).
  • Stefania Guida
    University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.).
  • Annalisa Turco
    University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.).
  • Simone Sala
    San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.).
  • Aitor Uribarri
    Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain (A.U.).
  • Caroline M. Van de Heyning
    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.).
  • Massimo Mapelli
    Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).
  • Jeness Campodonico
    Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).
  • Patrizia Pedrotti
    De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).
  • Maria Isabel Barrionuevo Sánchez
    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.).
  • Albert Ariza Sole
    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.).
  • Marco Marini
    Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I–GM Lancisi–G Salesi, Ancona, Italy (M. Marini, M.V.M.).
  • Maria Vittoria Matassini
    Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I–GM Lancisi–G Salesi, Ancona, Italy (M. Marini, M.V.M.).
  • Mickael Vourc’h
    Department of Anesthesiology and Surgical Intensive Care, Hôpital Laennec, University Hospital of Nantes, France (M.V.).
  • Antonio Cannatà
    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.).
  • Daniel I. Bromage
    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.).
  • Daniele Briguglia
    Mater Domini Humanitas Hospital, Castellanza, Italy (D.B.).
  • Jorge Salamanca
    Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.).
  • Pablo Diez-Villanueva
    Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.).
  • Jukka Lehtonen
    Heart and Lung Center, Department of Cardiology, Helsinki University Hospital, Finland (J.L.).
  • Florent Huang
    Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel).
  • Stéphanie Russel
    Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel).
  • Francesco Soriano
    De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).
  • Fabrizio Turrini
    Ospedale Civile di Baggiovara, Modena, Italy (F.T.).
  • Manlio Cipriani
    De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).
  • Manuela Bramerio
    Department of Histopathology, Niguarda Hospital, Milano, Italy (M.B.).
  • Mattia Di Pasquale
    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).
  • Aurelia Grosu
    Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni).
  • Michele Senni
    Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni).
  • Davide Farina
    Institute of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (D.F.).
  • Piergiuseppe Agostoni
    Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).
  • Stefania Rizzo
    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.).
  • Monica De Gaspari
    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.).
  • Francesca Marzo
    Department of Cardiology, Infermi Hospital, Rimini, Italy (F.M.).
  • Jason M. Duran
    Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.).
  • Eric D. Adler
    Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.).
  • Cristina Giannattasio
    De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).
  • Cristina Basso
    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.).
  • Theresa McDonagh
    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.).
  • Mathieu Kerneis
    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.).
  • Alain Combes
    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).
  • Paolo G. Camici
    San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.).
  • James A. de Lemos
    Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.).
  • Marco Metra
    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).

Abstract

<jats:sec> <jats:title>Background:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> 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 ( <jats:italic>P</jats:italic> =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; <jats:italic>P</jats:italic> <0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>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.</jats:p> </jats:sec>

Journal

  • Circulation

    Circulation 145 (15), 1123-1139, 2022-04-12

    Ovid Technologies (Wolters Kluwer Health)

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