Coronavirus-induced myocarditis: A meta-summary of cases

Jamie Sy Ho, Ching-Hui Sia, Mark Yy Chan, Weiqin Lin, Raymond Cc Wong, Jamie Sy Ho, Ching-Hui Sia, Mark Yy Chan, Weiqin Lin, Raymond Cc Wong

Abstract

Background: Myocarditis caused by SARS-CoV-2 infection was proposed to account for a proportion of cardiac injury in patients with COVID-19. However, reports of coronavirus-induced myocarditis were scarce. The aim of this review was to summarise the published cases of myocarditis and describe their presentations, diagnostic processes, clinical characteristics and outcomes.

Methods: A literature search of MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL and OpenGrey on was performed on 3 June 2020. Studies of myocarditis in patients with COVID-19 were included, and those only reporting cardiac injury or heart failure were excluded. Cases were "confirmed" myocarditis if diagnosed on cardiac magnetic resonance imaging (CMR) or histopathology. Those without were grouped as "possible" myocarditis.

Results: A total of 31 studies on 51 patients were included; 12 cases were confirmed myocarditis while 39 had possible myocarditis. The median age was 55 and 69% were male. The most common presenting symptoms were fever, shortness of breath, cough and chest pain. Electrocardiogram changes included non-specific ST-segment and T-wave changes and ventricular tachycardia. Most patients had elevated cardiac and inflammatory biomarkers. Left ventricular dysfunction and hypokinesis was common. CMR established the diagnosis in 10 patients, with features of cardiac oedema and cardiac injury. Five patients had histopathological examination. Some cases required mechanical ventilation and extracoporeal membrane oxygenation, and 30% of patients recovered but 27% died.

Conclusions: COVID-19 myocarditis was associated with ECG, cardiac biomarker and echocardiographic changes, and the manifestation could be severe leading to mortality. Endomyocardial biopsy was not available in most cases but CMR was valuable.

Keywords: COVID-19; Coronavirus; Meta-summary; Myocarditis.

Conflict of interest statement

Declaration of Competing Interest None declared

Copyright © 2020 Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the process of literature search, screening and inclusion of studies.

References

    1. Guo T., Fan Y., Chen M. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (covid-19) JAMA Cardiol. 2020
    1. Esfandiarei M., McManus B.M. Molecular biology and pathogenesis of viral myocarditis. Annu Rev Pathol. 2008;3:127–155.
    1. Driggin E., Madhavan M.V., Bikdeli B. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (covid-19) pandemic. J Am Coll Cardiol. 2020;18
    1. Murad M.H., Sultan S., Haffar S., Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid-Base Med. 2018;23:60.
    1. 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 Rep. 2020
    1. Sala S., Peretto G., Gramegna M. Acute myocarditis presenting as a reverse tako-tsubo syndrome in a patient with sars-cov-2 respiratory infection. Eur Heart J. 2020;41:1861–1862.
    1. Yuan W.-.F., Tang X., Zhao X.-.X. An “asymptomatic” driver with covid-19: atypical suspected myocarditis by sars-cov-2. Cardiovasc Diagn The. 2020;10:242–243.
    1. Beri A., Kotak K. Cardiac injury, arrhythmia, and sudden death in a covid-19 patient. HeartRhythm Case Rep. 2020
    1. Inciardi R.M., Lupi L., Zaccone G. Cardiac involvement in a patient with coronavirus disease 2019 (covid-19) JAMA Cardiol. 2020
    1. Liu Y., Yang Y., Zhang C. Clinical and biochemical indexes from 2019-ncov infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63:364–374.
    1. Jiang S.W., Gao H., Wu L. Clinical feature changes of a covid-19 patient from mild to critical condition and cardiopulmonary pathological results. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48:E018.
    1. Hu H., Ma F., Wei X., Fang Y. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin. Eur Heart J. 2020
    1. Kim I.C., Kim J.Y., Kim H.A., Han S. Covid-19-related myocarditis in a 21-year-old female patient. Eur Heart J. 2020;41:1859.
    1. Luetkens J.A., Isaak A., Zimmer S. Diffuse myocardial inflammation in covid-19 associated myocarditis detected by multiparametric cardiac magnetic resonance imaging. Circ Cardiovasc Imaging. 2020;13
    1. Craver R., Huber S., Sandomirsky M., McKenna D., Schieffelin J., Finger L. Fatal eosinophilic myocarditis in a healthy 17-year-old male with severe acute respiratory syndrome coronavirus 2 (sars-cov-2c) Fetal Pediatr Pathol. 2020
    1. Zeng J.-.H., Liu Y.-.X., Yuan J. First case of covid-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020
    1. Irabien-Ortiz A., Carreras-Mora J., Sionis A., Pamies J., Montiel J., Tauron M. Fulminant myocarditis due to covid-19. Rev Esp Cardiol. 2020
    1. Hua A., O'Gallagher K., Sado D., Byrne J. Life-threatening cardiac tamponade complicating myo-pericarditis in covid-19. Eur Heart J. 2020
    1. Rauf A., Vijayan A., John S.T., Krishnan R., Latheef A. Multisystem inflammatory syndrome with features of atypical kawasaki disease during covid-19 pandemic. Indian J Pediatr. 2020
    1. Tavazzi G., Pellegrini C., Maurelli M. Myocardial localization of coronavirus in covid-19 cardiogenic shock. Eur J Heart Fail. 2020
    1. Sardari A., Tabarsi P., Borhany H., Mohiaddin R., Houshmand G. Myocarditis detected after covid-19 recovery. Eur Heart J Cardiovasc Imaging. 2020
    1. Doyen D., Moceri P., Ducreux D., Dellamonica J. Myocarditis in a patient with covid-19: a cause of raised troponin and ecg changes. Lancet. 2020;395:1516.
    1. Paul J.F., Charles P., Richaud C., Caussin C., Diakov C. Myocarditis revealing covid-19 infection in a young patient. Eur Heart J Cardiovasc Imaging. 2020
    1. Oberweis M.-.L., Codreanu A., Boehm W. Pediatric life-threatening coronavirus disease 2019 with myocarditis. Pediatr Infect Dis J. 2020
    1. Warchol I., Debska-Kozlowska A., Karcz-Socha I., Ksiazczyk M., Szymanska K., Lubinski A. Terra incognita: clinically suspected myocarditis in a sars-cov-2 positive patient. Pol Arch Intern Med. 2020
    1. Fried J.A., Ramasubbu K., Bhatt R. The variety of cardiovascular presentations of covid-19. Circulation. 2020 0.
    1. Asif T., Ali Z. Transient st segment elevation in two patients with covid-19 and a normal transthoracic echocardiogram. Eur J Case Rep Intern Med. 2020;7
    1. Radbel J., Narayanan N., Bhatt P.J. Use of tocilizumab for covid-19-induced cytokine release syndrome: a cautionary case report. Chest. 2020
    1. Khalid N., Chen Y., Case B.C. Covid-19 (sars-cov-2) and the heart - an ominous association. Cardiovasc Revasc. 2020
    1. Fernandez-Ruiz M., Andres A., Loinaz C. Covid-19 in solid organ transplant recipients: a single-center case series from Spain. Am J Transplant. 2020
    1. Nunes Duarte-Neto A., de Almeida Monteiro R.A., da Silva L.F.F. Pulmonary and systemic involvement of covid-19 assessed by ultrasound-guided minimally invasive autopsy. Histopathology. 2020
    1. Buja L.M., Wolf D., Zhao B. The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (covid-19): report of 3 autopsies from houston, texas, and review of autopsy findings from other United States cities. Cardiovasc Pathol. 2020;48
    1. Secco G.G., Tarantini G., Mazzarotto P. Invasive strategy for covid patients presenting with acute coronary syndrome: the first multicenter Italian experience. Catheter Cardiovasc Interv. 2020
    1. Ruan Q., Yang K., Wang W., Jiang L., Song J. Clinical predictors of mortality due to covid-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46:846–848.
    1. Deng Q., Hu B., Zhang Y. Suspected myocardial injury in patients with covid-19: evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. 2020
    1. Friedrich M.G., Sechtem U., Schulz-Menger J. Cardiovascular magnetic resonance in myocarditis: a jacc white paper. J Am Coll Cardiol. 2009;53:1475.
    1. Baughman Kenneth L. Diagnosis of myocarditis. Circulation. 2006;113:593–595.
    1. Santoso A., Pranata R., Wibowo A., Al-Farabi M.J., Huang I., Antariksa B. Cardiac injury is associated with mortality and critically ill pneumonia in covid-19: a meta-analysis. Am J Emerg Med. 2020
    1. Ho J.S., Tambyah P.A., Ho A.F., Chan M.Y., Sia C.-.H. Effect of coronavirus infection on the human heart: a scoping review. Eur J Prev Cardiol. 2020 2047487320925965.
    1. Veronese G., Ammirati E., Cipriani M., Frigerio M. Fulminant myocarditis: characteristics, treatment, and outcomes. Anatol J Cardiol. 2018;19:279–286.
    1. Felker G.M., Boehmer J.P., Hruban R.H. Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol. 2000;36:227–232.
    1. Friedrich M.G., Marcotte F. Cardiac magnetic resonance assessment of myocarditis. Circ Cardiovasc Imaging. 2013;6:833–839.
    1. Caforio A.L.P., Pankuweit S., Arbustini E. 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. Eur Heart J. 2013;34:2636–2648.
    1. Yang Z., Liu J., Zhou Y., Zhao X., Zhao Q., Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect. 2020
    1. Horby P., Lim W.S., Emberson J., et al. Effect of dexamethasone in hospitalized patients with covid-19: preliminary report. medRxiv. 2020:2020. 2006.2022.20137273
    1. Toubiana J., Poirault C., Corsia A. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:m2094.
    1. Viner R.M., Whittaker E. Kawasaki-like disease: emerging complication during the covid-19 pandemic. Lancet. 2020;395:1741–1743.

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