1
|
Cersosimo A, Di Pasquale M, Arabia G, Metra M, Vizzardi E. COVID myocarditis: a review of the literature. Monaldi Arch Chest Dis 2023. [PMID: 37930657 DOI: 10.4081/monaldi.2023.2784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
Myocarditis is a potentially fatal complication of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. COVID-19 myocarditis appears to have distinct inflammatory characteristics that distinguish it from other viral etiologies. COVID-19 myocarditis can present with symptoms ranging from dyspnea and chest pain to acute heart failure and death. It is critical to detect any cases of myocarditis, especially fulminant myocarditis, which can be characterized by signs of heart failure and arrhythmias. Serial troponins, echocardiography, and electrocardiograms should be performed as part of the initial workup for suspected myocarditis. The second step in detecting myocarditis is cardiac magnetic resonance imaging and endomyocardial biopsy. Treatment for COVID-19 myocarditis is still debatable; however, combining intravenous immunoglobulins and corticosteroids may be effective, especially in cases of fulminant myocarditis. Overall, more research is needed to determine the incidence of COVID-19 myocarditis , and the use of intravenous immunoglobulins and corticosteroids in combination requires large randomized controlled trials to determine efficacy. The purpose of this review is to summarize current evidence on the subject. This review aims to summarise current evidence on this topic.
Collapse
Affiliation(s)
- Angelica Cersosimo
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
| | - Mattia Di Pasquale
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
| | - Gianmarco Arabia
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
| | - Enrico Vizzardi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
| |
Collapse
|
2
|
Restelli D, Carerj ML, Bella GD, Zito C, Poleggi C, D’Angelo T, Donato R, Ascenti G, Blandino A, Micari A, Mazziotti S, Minutoli F, Baldari S, Carerj S. Constrictive Pericarditis: An Update on Noninvasive Multimodal Diagnosis. J Cardiovasc Echogr 2023; 33:161-170. [PMID: 38486689 PMCID: PMC10936705 DOI: 10.4103/jcecho.jcecho_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 03/17/2024] Open
Abstract
Constrictive pericarditis (CP) is a rare condition that can affect the pericardium after every pericardial disease process and has been described even after SARS-CoV-2 infection or vaccine. In CP, the affected pericardium, usually the inner layer, is noncompliant, constraining the heart to a fixed maximum volume and impairing the diastolic function. This leads to several clinical features, that, however, can be pleomorphic. In its difficult diagnostic workup, noninvasive multimodal imaging plays a central role, providing important morphological and functional data, like the enhanced ventricular interdependence and the dissociation between intrathoracic and intracardiac pressures. An early and proper diagnosis is crucial to set an appropriate therapy, changing the prognosis of patients affected by CP. In this review, we cover in detail the main elements of each imaging technique, after a reminder of pathophysiology useful for understanding the diagnostic findings.
Collapse
Affiliation(s)
- Davide Restelli
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Maria Ludovica Carerj
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Cristina Poleggi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Tommaso D’Angelo
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Rocco Donato
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Antonio Micari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Fabio Minutoli
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| |
Collapse
|
3
|
Bailey E, Frishman WH. Mild-to-Moderate COVID-19 Infection and Myocarditis: A Review. Cardiol Rev 2023; 31:173-175. [PMID: 35576368 DOI: 10.1097/crd.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has taken a massive toll on healthcare systems internationally. Severe illness has been seen in a range of patient populations, but those living with cardiovascular disease have suffered to a greater extent, likely because of their comorbidities. In patients with diabetes, hypertension, heart failure, and other chronic illnesses, COVID-19 has manifested severe illnesses such as coagulopathies, myocarditis, and arrhythmias, complicating the disease course for those already suffering from underlying illness. There have been numerous studies done exploring the cardiovascular complications of COVID-19. Some of the more concerning findings have revealed a correlation between severe illness and the increasing likelihood for developing cardiovascular manifestations. However, what is more concerning were the studies revealing the presence of myocarditis and other cardiac sequelae in previously healthy patients with mild or asymptomatic COVID-19. The goal of this article is to review the literature to compile information available about whether there is a significant risk of myocarditis in those patients who do not develop severe initial COVID-19 disease.
Collapse
Affiliation(s)
- Eric Bailey
- From the Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - William H Frishman
- Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
| |
Collapse
|
4
|
Samimisedeh P, Sehati F, Jafari Afshar E. COVID-19 Associated Fulminant Myocarditis in a Fully-Vaccinated Female: A Case Report with Clinical Follow-up. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476221147238. [PMID: 36776728 PMCID: PMC9912035 DOI: 10.1177/11795476221147238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 02/10/2023]
Abstract
Background Myocarditis is considered a serious adverse event after COVID-19 infection. The risk and severity of myocarditis after COVID-19 disease decreased significantly in the vaccinated population. We present a case of cardiac magnetic resonance proven fulminant myocarditis following COVID-19 disease in a young female who was previously vaccinated with 2 doses of the BIBP (Sinopharm) vaccine. Case summary A 29-year-old female was referred to the hospital with acute chest pain, dyspnea, and nausea. Her electrocardiogram revealed ST-segment elevation in anterolateral leads with reciprocal changes in inferior leads. She was primarily diagnosed with ST-elevation myocardial infarction following spontaneous coronary artery dissection (SCAD) according to her age and gender. Her coronary angiography was normal. RT-PCR nasopharyngeal swab was positive for SARS-COV-2 infection. According to her history and excluding coronary artery diseases, she was clinically diagnosed with myocarditis and received corticosteroids, IVIG, and colchicine. She was discharged in a favorable condition after 11 days of hospitalization. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis according to the updated lake Louise criteria. On her 4-month follow-up, she was asymptomatic, and her echocardiography showed improvement in biventricular function. Discussion The diagnosis of myocarditis caused by COVID-19 infection may be challenging as the symptoms of myocarditis, and COVID-19 disease may overlap. It should be considered when patients have acute chest pain, palpitation, elevated cardiac biomarkers, and new abnormalities in ECG or echocardiography. Cardiac MRI is a non-invasive gold standard modality for diagnosing and follow-up of myocarditis and should be used in clinically suspected myocarditis. The long-term course of myocarditis following COVID-19 disease is still unclear, but some evidence suggests it may have a favorable mid-term outcome.
Collapse
Affiliation(s)
| | - Fatemeh Sehati
- Fatemeh Sehati, Cardiovascular Research
Center, Alborz University of Medical Sciences, Karaj, R2V4+2VX, Iran.
| | | |
Collapse
|
5
|
Barreiro-Pérez M, Pueyo PP, Roubin SR, Corominas DM, Uribarri A, Bachiller RE, Rozado Castaño J, Álvarez LGC, Fernández LS, Domínguez F, Figal DP. [Myocarditis related SARS-CoV-2 infection or vaccination: an expert consensus statement on its diagnosis and management]. Rev Esp Cardiol 2023:S0300-8932(23)00052-0. [PMID: 36743295 PMCID: PMC9884510 DOI: 10.1016/j.recesp.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revealed several cardiovascular complications, including myocarditis caused by SARS-CoV-2 infection (COVID-19) or after messenger RNA vaccines. The high prevalence of COVID-19, vaccination programs expansion, and the appearance of new information regarding myocarditis in these contexts make it necessary to condense the knowledge acquired since the pandemic began. With this aim, the Myocarditis Working Group of the Heart Failure Association of the Spanish Society of Cardiology, with the collaboration of the Spanish Agency for Medicines and Health Products (AEMPS), has written this document. It aims to address the diagnosis and treatment of cases of myocarditis-associated SARS-CoV-2 infection or messenger RNA vaccine.
Collapse
Affiliation(s)
- Manuel Barreiro-Pérez
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, España
| | - Pablo Pastor Pueyo
- Unidad de Cardiología Clínica y Cuidados Agudos Cardiovasculares, Hospital Universitario Arnau de Vilanova, Lleida, España
- Institut de Reserca Biomèdica Lleida (IRB-Lleida), Lleida, España
| | - Sergio Raposeiras Roubin
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, España
| | - Dolores Montero Corominas
- División de Farmacoepidemiología y Farmacovigilancia, Departamento de Medicamentos de Uso Humano, Agencia Española de Medicamentos y Productos Sanitarios, Madrid, España
| | - Aitor Uribarri
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Rocío Eiros Bachiller
- Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, España
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - José Rozado Castaño
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Luis Serratosa Fernández
- Unidad de Cardiología del Deporte, Hospital Universitario Quirónsalud Madrid, Madrid, España
- Unidad de Cardiología del Deporte, Centro de Medicina Deportiva Olympia Quirónsalud, Madrid, España
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Domingo Pascual Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
| |
Collapse
|
6
|
Davis MG, Bobba A, Chourasia P, Gangu K, Shuja H, Dandachi D, Farooq A, Avula SR, Shekhar R, Sheikh AB. COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample. Viruses 2022; 14:2791. [PMID: 36560794 PMCID: PMC9785561 DOI: 10.3390/v14122791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Coronavirus-19 (COVID-19), preliminarily a respiratory virus, can affect multiple organs, including the heart. Myocarditis is a well-known complication among COVID-19 infections, with limited large-scale studies evaluating outcomes associated with COVID-19-related Myocarditis. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without Myocarditis. A total of 1,659,040 patients were included in the study: COVID-19 with Myocarditis (n = 6,455, 0.4%) and COVID-19 without Myocarditis (n = 1,652,585, 99.6%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, sudden cardiac arrest, cardiogenic shock, acute kidney injury requiring hemodialysis, length of stay, health care utilization costs, and disposition. We conducted a secondary analysis with propensity matching to confirm results obtained by traditional multivariate analysis. COVID-19 patients with Myocarditis had significantly higher in-hospital mortality compared to COVID-19 patients without Myocarditis (30.5% vs. 13.1%, adjusted OR: 3 [95% CI 2.1-4.2], p < 0.001). This cohort also had significantly increased cardiogenic shock, acute kidney injury requiring hemodialysis, sudden cardiac death, required more mechanical ventilation and vasopressor support and higher hospitalization cost. Vaccination and more research for treatment strategies will be critical for reducing worse outcomes in patients with COVID-19-related Myocarditis.
Collapse
Affiliation(s)
- Monique G. Davis
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Aniesh Bobba
- Department of Medicine, John H Stronger Hospital, Cook County, Chicago, IL 60612, USA
| | - Prabal Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA 22401, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Hina Shuja
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Dima Dandachi
- Division of Infectious Diseases, University of Missouri-Columbia, Columbia, MO 65211, USA
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, TX 79409, USA
| | - Sindhu Reddy Avula
- Department of Interventional Cardiology, Division of Cardiology, University of Kansas, St Francis Campus, Kansas City, KS 66606, USA
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| |
Collapse
|
7
|
Voleti N, Reddy SP, Ssentongo P. Myocarditis in SARS-CoV-2 infection vs. COVID-19 vaccination: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:951314. [PMID: 36105535 PMCID: PMC9467278 DOI: 10.3389/fcvm.2022.951314] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to compare the incidence of myocarditis in COVID-19 vaccines and in severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection groups. Methods Electronic databases (MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the WHO Global Literature on Coronavirus Disease) and trial registries were searched up to May 2022, for randomized controlled trials and observational cohort studies reporting the risk of myocarditis associated with the COVID-19 vaccines and the risk associated with SARS-CoV-2 infection. We estimated the effect of COVID-19 infection and vaccines on rates of myocarditis by random-effects meta-analyses using the generic inverse variance method. Meta-regression analyses were conducted to assess the effect of sex and age on the incidence of myocarditis. Results We identified 22 eligible studies consisting of 55.5 million vaccinated cohorts and 2.5 million in the infection cohort. The median age was 49 years (interquartile range (IQR): 38–56), and 49% (IQR: 43 to 52%) were men. Of patients diagnosed with myocarditis (in both vaccination and COVID-19 cohort) 1.07% were hospitalized and 0.015% died. The relative risk (RR) for myocarditis was more than seven times higher in the infection group than in the vaccination group [RR: 15 (95% CI: 11.09–19.81, infection group] and RR: 2 (95% CI: 1.44-2.65, vaccine group). Of patients who developed myocarditis after receiving the vaccine or having the infection, 61% (IQR: 39–87%) were men. Meta-regression analysis indicated that men and younger populations had a higher risk of myocarditis. A slow decline in the rates of myocarditis was observed as a function of time from vaccination. The risk of bias was low. Conclusion In this systematic review and meta-analysis, we found that the risk of myocarditis is more than seven fold higher in persons who were infected with the SARS-CoV-2 than in those who received the vaccine. These findings support the continued use of mRNA COVID-19 vaccines among all eligible persons per CDC and WHO recommendations.
Collapse
Affiliation(s)
- Navya Voleti
- Department of Medicine, Penn State Health Medical Center, Hershey, PA, United States
| | | | - Paddy Ssentongo
- Department of Medicine, Penn State Health Medical Center, Hershey, PA, United States
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
- *Correspondence: Paddy Ssentongo
| |
Collapse
|
8
|
Fritz RO, Betageri O, Chakrala T, Kim J, Al-Ani M, Omar A. Severe myopericarditis following the third dose of an mRNA COVID-19 vaccine: utility of a multimodal treatment approach. BMJ Case Rep 2022; 15:15/6/e249533. [PMID: 35768161 PMCID: PMC9243494 DOI: 10.1136/bcr-2022-249533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We report a rare case of severe myopericarditis in a healthy man in his 20s after the third dose of an mRNA COVID-19 vaccine. His symptoms and troponinemia resolved with a beta-blocker in addition to standard anti-inflammatory therapy, highlighting the utility of multimodal therapy.
Collapse
Affiliation(s)
- Rachel Olivia Fritz
- Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Omkar Betageri
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Teja Chakrala
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Justin Kim
- Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mohammad Al-Ani
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Abdullah Omar
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| |
Collapse
|
9
|
Licordari R, Sticchi A, Mancuso F, Caracciolo A, Muscoli S, Iacovelli F, Ruggiero R, Scoccia A, Cammalleri V, Pavani M, Loffi M, Scordino D, Ferro J, Rognoni A, Buono A, Nava S, Albani S, Colaiori I, Zilio F, Borghesi M, Regazzoni V, Benenati S, Pescetelli F, De Marzo V, Mannarini A, Spione F, Baldassarre D, De Benedictis M, Bonmassari R, Danzi GB, Galli M, Ielasi A, Musumeci G, Tomai F, Pasceri V, Porto I, Patti G, Campo G, Colombo A, Micari A, Giannini F, Costa F. The Incidence and Impact of In-Hospital Bleeding in Patients with Acute Coronary Syndrome during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11102926. [PMID: 35629052 PMCID: PMC9146584 DOI: 10.3390/jcm11102926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The COVID-19 pandemic increased the complexity of the clinical management and pharmacological treatment of patients presenting with an Acute Coronary Syndrome (ACS). Aim: to explore the incidence and prognostic impact of in-hospital bleeding in patients presenting with ACS before and during the COVID-19 pandemic. Methods: We evaluated in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding among 2851 patients with ACS from 17 Italian centers during the first wave of the COVID-19 pandemic (i.e., March–April 2020) and in the same period in the previous two years. Results: The incidence of in-hospital TIMI major and minor bleeding was similar before and during the COVID-19 pandemic. TIMI major or minor bleeding was associated with a significant threefold increase in all-cause mortality, with a similar prognostic impact before and during the COVID-19 pandemic. Conclusions: the incidence and clinical impact of in-hospital bleeding in ACS patients was similar before and during the COVID-19 pandemic. We confirmed a significant and sizable negative prognostic impact of in-hospital bleeding in ACS patients.
Collapse
Affiliation(s)
- Roberto Licordari
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Alessandro Sticchi
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Centro per la Lotta Contro L’Infarto (CLI) Foundation, 00182 Rome, Italy
- Department of Cardiology, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Filippo Mancuso
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, 00133 Rome, Italy; (S.M.); (V.C.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Rossella Ruggiero
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Alessandra Scoccia
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, 00133 Rome, Italy; (S.M.); (V.C.)
| | - Marco Pavani
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Marco Loffi
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Domenico Scordino
- Division of Cardiology, Aurelia Hospital, 00165 Rome, Italy; (D.S.); (F.T.)
| | - Jayme Ferro
- U.O.S.D. Cardiologia-Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, 22100 Como, Italy; (J.F.); (M.G.)
| | - Andrea Rognoni
- Department of Cardiology, Azienda Ospedaliero–Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.R.); (G.P.)
| | - Andrea Buono
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (A.B.); (A.I.)
| | - Stefano Nava
- Division of Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Stefano Albani
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy; (S.A.); (G.M.)
| | - Iginio Colaiori
- Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Filippo Zilio
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Marco Borghesi
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Valentina Regazzoni
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Stefano Benenati
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Fabio Pescetelli
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Vincenzo De Marzo
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Antonia Mannarini
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Doronzo Baldassarre
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Michele De Benedictis
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Roberto Bonmassari
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Gian Battista Danzi
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Mario Galli
- U.O.S.D. Cardiologia-Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, 22100 Como, Italy; (J.F.); (M.G.)
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (A.B.); (A.I.)
| | - Giuseppe Musumeci
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy; (S.A.); (G.M.)
| | - Fabrizio Tomai
- Division of Cardiology, Aurelia Hospital, 00165 Rome, Italy; (D.S.); (F.T.)
| | - Vincenzo Pasceri
- Department of Cardiology, San Filippo Neri Roma, 00135 Rome, Italy;
| | - Italo Porto
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Giuseppe Patti
- Department of Cardiology, Azienda Ospedaliero–Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.R.); (G.P.)
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Antonio Colombo
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
| | - Antonio Micari
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Francesco Giannini
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
- Correspondence:
| |
Collapse
|
10
|
Ali M, Shiwani HA, Elfaki MY, Hamid M, Pharithi R, Kamgang R, Egom CB, Oyono JLE, Egom EEA. COVID-19 and myocarditis: a review of literature. Egypt Heart J 2022; 74:23. [PMID: 35380300 PMCID: PMC8980789 DOI: 10.1186/s43044-022-00260-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
Myocarditis has been discovered to be a significant complication of coronavirus disease 2019 (COVID-19), a condition caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. COVID-19 myocarditis seems to have distinct inflammatory characteristics, which make it unique to other viral etiologies. The incidence of COVID-19 myocarditis is still not clear as a wide range of figures have been quoted in the literature; however, it seems that the risk of developing myocarditis increases with more severe infection. Furthermore, the administration of the mRNA COVID-19 vaccine has been associated with the development of myocarditis, particularly after the second dose. COVID-19 myocarditis has a wide variety of presentations, ranging from dyspnea and chest pain to acute heart failure and possibly death. It is important to catch any cases of myocarditis, particularly those presenting with fulminant myocarditis which can be characterized by signs of heart failure and arrythmias. Initial work up for suspected myocarditis should include serial troponins and electrocardiograms. If myocardial damage is detected in these tests, further screening should be carried out. Cardiac magnetic resonance imagining and endomyocardial biopsy are the most useful tests for myocarditis. Treatment for COVID-19 myocarditis is still controversial; however, the use of intravenous immunoglobulins and corticosteroids in combination may be effective, particularly in cases of fulminant myocarditis. Overall, the incidence of COVID-19 myocarditis requires further research, while the use of intravenous immunoglobulins and corticosteroids in conjunction requires large randomized controlled trials to determine their efficacy.
Collapse
Affiliation(s)
- Mohammed Ali
- School of Medicine, The University of Manchester, Stopford Building, 99 Oxford Road, Manchester, M13 9PG, UK.
| | | | | | - Moaz Hamid
- Birmingham Midland Eye Centre, Birmingham, UK
| | | | - Rene Kamgang
- St Vincent's University Hospital, Dublin, Ireland
| | | | - Jean Louis Essame Oyono
- Laboratory of Endocrinology and Radioisotopes, Institute of Medical Research and Medicinal Plants Studies (IMPM), Yaoundé, Cameroon
| | - Emmanuel Eroume-A Egom
- Laboratory of Endocrinology and Radioisotopes, Institute of Medical Research and Medicinal Plants Studies (IMPM), Yaoundé, Cameroon
- Institut du Savoir Montfort (ISM), Hôpital Montfort, 713 Montreal Rd, Ottawa, ON, K1K 0T2, Canada
| |
Collapse
|
11
|
Ling RR, Ramanathan K, Tan FL, Tai BC, Somani J, Fisher D, MacLaren G. Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis. THE LANCET RESPIRATORY MEDICINE 2022; 10:679-688. [PMID: 35421376 PMCID: PMC9000914 DOI: 10.1016/s2213-2600(22)00059-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 12/17/2022]
Abstract
Background Myopericarditis is a rare complication of vaccination. However, there have been increasing reports of myopericarditis following COVID-19 vaccination, especially among adolescents and young adults. We aimed to characterise the incidence of myopericarditis following COVID-19 vaccination, and compare this with non-COVID-19 vaccination. Methods We did a systematic review and meta-analysis, searching four international databases from Jan 1, 1947, to Dec 31, 2021, for studies in English reporting on the incidence of myopericarditis following vaccination (the primary outcome). We included studies reporting on people in the general population who had myopericarditis in temporal relation to receiving vaccines, and excluded studies on a specific subpopulation of patients, non-human studies, and studies in which the number of doses was not reported. Random-effects meta-analyses (DerSimonian and Laird) were conducted, and the intra-study risk of bias (Joanna Briggs Institute checklist) and certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluations approach) were assessed. We analysed the difference in incidence of myopericarditis among subpopulations, stratifying by the type of vaccine (COVID-19 vs non-COVID-19) and age group (adult vs paediatric). Among COVID-19 vaccinations, we examined the effect of the type of vaccine (mRNA or non-mRNA), sex, age, and dose on the incidence of myopericarditis. This study was registered with PROSPERO (CRD42021275477). Findings The overall incidence of myopericarditis from 22 studies (405 272 721 vaccine doses) was 33·3 cases (95% CI 15·3–72·6) per million vaccine doses, and did not differ significantly between people who received COVID-19 vaccines (18·2 [10·9–30·3], 11 studies [395 361 933 doses], high certainty) and those who received non-COVID-19 vaccines (56·0 [10·7–293·7], 11 studies [9 910 788 doses], moderate certainty, p=0·20). Compared with COVID-19 vaccination, the incidence of myopericarditis was significantly higher following smallpox vaccinations (132·1 [81·3–214·6], p<0·0001) but was not significantly different after influenza vaccinations (1·3 [0·0–884·1], p=0·43) or in studies reporting on various other non-smallpox vaccinations (57·0 [1·1–3036·6], p=0·58). Among people who received COVID-19 vaccines, the incidence of myopericarditis was significantly higher in males (vs females), in people younger than 30 years (vs 30 years or older), after receiving an mRNA vaccine (vs non-mRNA vaccine), and after a second dose of vaccine (vs a first or third dose). Interpretation The overall risk of myopericarditis after receiving a COVID-19 vaccine is low. However, younger males have an increased incidence of myopericarditis, particularly after receiving mRNA vaccines. Nevertheless, the risks of such rare adverse events should be balanced against the risks of COVID-19 infection (including myopericarditis). Funding None.
Collapse
Affiliation(s)
- Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore.
| | - Felicia Liying Tan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Bee Choo Tai
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Jyoti Somani
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore
| |
Collapse
|
12
|
Incidence of Myopericarditis and Myocardial Injury in Coronavirus Disease 2019 Vaccinated Subjects. Am J Cardiol 2022; 164:123-130. [PMID: 34852929 PMCID: PMC8627580 DOI: 10.1016/j.amjcard.2021.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
Several recent publications have described myopericarditis cases after the coronavirus disease 2019 (COVID-19) vaccination. However, it is uncertain if these cases occurred secondary to the vaccination or more common etiologies of myopericarditis. To help determine whether a correlation exists between COVID-19 vaccination and myopericarditis, the present study compared the gender-specific cumulative incidence of myopericarditis and myocardial injury in a cohort of COVID-19 vaccinated patients at a tertiary care center in 2021 with the cumulative incidence of these conditions in the same subjects exactly 2 years earlier. We found that the age-adjusted incidence rate of myopericarditis in men was higher in the vaccinated than the control population, rate ratio 9.7 (p = 0.04). However, the age-adjusted incidence rate of myopericarditis in women was no different between the vaccinated and control populations, rate ratio 1.28 (p = 0.71). We further found that the rate of myocardial injury was higher in both men and women in 2021 than in 2019 both before and after vaccination, suggesting that some of the apparent increase in the diagnosis of myopericarditis after vaccination may be attributable to factors unrelated to the COVID-19 vaccinations. In conclusion, our study reaffirms the apparent increase in the diagnosis of myopericarditis after COVID-19 vaccination in men but not in women, although this finding may be confounded by increased rates of myocardial injury in 2021. The benefits of COVID-19 vaccination to individual and public health clearly outweigh the small potential increased risk of myopericarditis after vaccination.
Collapse
|
13
|
Kermani-Alghoraishi M, Pouramini A, Kafi F, Khosravi A. Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From Pathogenesis to Management: A Case Report Based Systematic Review. Curr Probl Cardiol 2022; 47:100933. [PMID: 34404552 PMCID: PMC8302828 DOI: 10.1016/j.cpcardiol.2021.100933] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
The Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) created a global pandemic that continues to this day. In addition to pulmonary symptoms, the virus can have destructive effects on other organs, especially the heart. For example, large pericardial effusion has been observed as a critical and life-threatening finding in Coronavirus disease of 2019 (COVID-19) patients. In this case report based systematic review, we review the reports of moderate to severe pericardial effusion associated with tamponade physiology. Direct cardiomyocyte and pericardium invasion, inflammation and cytokine storms and oxidative stress due to acute respiratory distress syndrome, are the pathogenesis of this phenomenon. The results showed that the manifestations of this finding are variable. Pericardial effusion can be seen as a delayed complication, accompanied by myocarditis or pericarditis, isolated, or with acute respiratory distress syndrome. In most patients, emergency percutaneous pericardiocentesis was performed, and fluid analysis was often exudative in 3 pattern of hemorrhagic, serous, and serosanguinous. Medical treatment and follow-up are recommended, especially in cases of pericarditis.
Collapse
Affiliation(s)
- Mohammad Kermani-Alghoraishi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Pouramini
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Kafi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Alireza Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
14
|
Cardiovascular System during SARS-CoV-2 Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031184. [PMID: 35162207 PMCID: PMC8835041 DOI: 10.3390/ijerph19031184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/20/2022]
Abstract
SARS-CoV-2 virus can not only damage the respiratory system but may also pose a threat to other organs, such as the heart or vessels. This review focuses on cardiovascular complications of COVID-19, including acute cardiac injury, arrhythmias, biomarkers, accompanying comorbidities and outcomes in patients diagnosed with SARS-CoV-2 infection. The research was conducted on the databases: PubMed, Springer, ScienceDirect, UpToDate, Oxford Academic, Wiley Online Library, ClinicalKey. Fifty-six publications from 1 November 2020 till 15 August 2021 were included in this study. The results show that cardiac injury is present in about 1 in 4 patients with COVID-19 disease, and it is an independent risk factor, which multiplies the death rate several times in comparison to infected patients without myocardial injury. New-onset cardiac injury occurs in nearly every 10th patient of the COVID-19-suffering population. Comorbidities (such as hypertension, cardiovascular disease and diabetes) severely deteriorate the outcome. Therefore, patients with SARS-CoV-2 infection should be carefully assessed in terms of cardiac medical history and possible cardiological complications.
Collapse
|
15
|
Patil A, Rao N, Kumar K, Modi T, Gandhi C, Deb S, Bose S, Saxena N, Katyal A, Thakare S, Pajai AE, Bajpai D, Jamale T. Cardiovascular Complications in Kidney Transplant Recipients with COVID-19: A Case Series. Indian J Nephrol 2022; 32:506-511. [PMID: 36568602 PMCID: PMC9775597 DOI: 10.4103/ijn.ijn_503_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 12/27/2022] Open
Abstract
Kidney transplant recipients (KTRs) are at a higher risk for developing severe COVID-19 which can be associated with cardiovascular complications. We studied five KTRs recipients infected with COVID-19 who developed severe cardiovascular complications. Two patients presented with ST segment myocardial infarction and two with clinically suspected myocarditis. One patient presented with atrial fibrillation. Two of these patients developed cardiogenic shock. Inflammatory markers were at peak during the event in four of these who had presented with severe COVID-19. Coronary angiography done in two patients with STEMI did not reveal any evidence of atherosclerotic coronary artery disease. Also, based on the cardiovascular (CV) risk estimation by Framingham score, four patients had low CV risk and one patient had intermediate CV risk. All five patients survived. Even with low CV risk, KTRs can develop myocardial injury and arrhythmias solely because of severe COVID-19.
Collapse
Affiliation(s)
- Ankita Patil
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India,Address for correspondence: Ankita Patil, Assistant Professor, Department of Nephrology, Ward No. 34A, Old Building Third Floor, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
| | - Nikhil Rao
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Kruteesh Kumar
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tulsi Modi
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Chintan Gandhi
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Satarupa Deb
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sreyashi Bose
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nikhil Saxena
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Abhinav Katyal
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sayali Thakare
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Atim E. Pajai
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Divya Bajpai
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tukaram Jamale
- Department of Nephrology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
16
|
Philip AM, George LJ, John KJ, George AA, Nayar J, Sahu KK, Selvaraj V, Lal A, Mishra AK. A review of the presentation and outcome of left ventricular thrombus in coronavirus disease 2019 infection. J Clin Transl Res 2021; 7:797-808. [PMID: 34988332 PMCID: PMC8715711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/22/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiovascular complications of the coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), have been documented both in the acute phase and in convalescence. One such complication is the formation of the left ventricular (LV) thrombus. There is a lack of clarity regarding the incidence, risk factors, and management of this complication. AIM The aim of the study is to identify the clinical presentation, risk factors and outcome of COVID-19 patients with left ventricular thrombus (LVT). METHODS A literature search was conducted to identify all case reports of COVID-19 with LVT in PubMed/Medline, Embase, Web of Science, and Google Scholar. RESULTS Among the 65 patients identified, 60 had LVT, either at admission, or during the acute phase of the illness. Six patients with mild symptoms during the acute phase of viral illness had only the COVID-19 antibody test positivity at the time LV thrombus was detected. Few of the patients (23.1%) had no comorbidities. The mean age of the patients was 52.8 years, and the youngest patient was 4 years old. This suggests that LVT formation can occur in young COVID-19 patients with no co-morbid conditions. Most of the patients (69.2%) had more than one site of thrombosis. A mortality rate of 23.1% was observed in our review, and ST-elevation myocardial infarction (STEMI) was diagnosed in 33.3% of those who died. CONCLUSIONS A high degree of suspicion for LVT must be maintained in patients with known cardiac disease and those with new-onset arterial or venous thromboembolism, and such patients may benefit from a screening echocardiography at admission. RELEVANCE FOR PATIENTS The patients with preexisting cardiovascular disease must take added precautions to prevent acquiring COVID-19 infection as there is a higher risk of developing LV thrombus. In patients who develop LVT in COVID-19, mortality rate is higher.
Collapse
Affiliation(s)
- Anil Mathew Philip
- 1Department of Medicine, St. Thomas Mission Hospital, Kattanam, India,Corresponding author: Anil Mathew Philip Department of Medicine, St. Thomas Mission Hospital, Kattanam, India. E-mail:
| | - Lina James George
- 2Department of Pulmonary Medicine, DR KM Cherian Institute of Medical Sciences, Kallissery, India
| | - Kevin John John
- 3Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Anu Anna George
- 4Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, 01608, USA
| | - Jemimah Nayar
- 5Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | - Kamal Kant Sahu
- 6Division of Hematooncology, Huntsman Cancer Institute, University of Utah, United States
| | - Vijairam Selvaraj
- 7Internal Medicine, Warren Apert School of Brown University, Miriam Hospital, 164 Summit Ave, Providence, 02906, RI
| | - Amos Lal
- 8Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Ajay Kumar Mishra
- 9Department of Internal Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts, 01608, USA
| |
Collapse
|
17
|
Mirabella S, Bansode O, Mashaal H, Akella J. COVID-19 Suspected myopericarditis without pulmonary involvement. Heart Lung 2021; 51:14-16. [PMID: 34731691 PMCID: PMC8501216 DOI: 10.1016/j.hrtlng.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/18/2022]
Abstract
Myopericarditis is a rare consequence of COVID-19 infection. Although extremely rare, COVID-19 can present without pulmonary involvement, and there have been reports of isolated cardiac involvement in one prior case We report a case of a young African American man presenting with myopericarditis following a recently recovered COVID-19 infection. Complicated by ICU admission requiring vasopressors; with eventual resolution following initiation of aspirin and colchicine for myopericarditis. Life threatening myopericarditis can occur following resolution of COVID-19 disease. The degree of cardiac involvement correlates poorly to the severity of pulmonary involvement.
Collapse
Affiliation(s)
- Steven Mirabella
- Department of Internal Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States of America; Department of Internal Medicine, Division of Pulmonary and Critical Care, Nassau University Medical Center, East Meadow, New York, United States of America.
| | - Oshin Bansode
- Department of Internal Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States of America; Department of Internal Medicine, Division of Pulmonary and Critical Care, Nassau University Medical Center, East Meadow, New York, United States of America
| | - Hyfaa Mashaal
- Department of Internal Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States of America; Department of Internal Medicine, Division of Pulmonary and Critical Care, Nassau University Medical Center, East Meadow, New York, United States of America
| | - Jagadish Akella
- Department of Internal Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States of America; Department of Internal Medicine, Division of Pulmonary and Critical Care, Nassau University Medical Center, East Meadow, New York, United States of America
| |
Collapse
|
18
|
Piccioni A, Saviano A, Cicchinelli S, Franza L, Rosa F, Zanza C, Santoro MC, Candelli M, Covino M, Nannini G, Amedei A, Franceschi F. Microbiota and Myopericarditis: The New Frontier in the Car-Diological Field to Prevent or Treat Inflammatory Cardiomyo-Pathies in COVID-19 Outbreak. Biomedicines 2021; 9:biomedicines9091234. [PMID: 34572420 PMCID: PMC8468627 DOI: 10.3390/biomedicines9091234] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 02/05/2023] Open
Abstract
Myopericarditis is an inflammatory heart condition involving the pericardium and myocardium. It can lead to heart failure, dilated cardiomyopathy, arrhythmia and sudden death. Its pathogenesis is mainly mediated by viral infections but also can be induced by bacterial infections, toxic substances and immune mediated disorders. All these conditions can produce severe inflammation and myocardial injury, often associated with a poor prognosis. The specific roles of these different pathogens (in particular viruses), the interaction with the host, the interplay with gut microbiota, and the immune system responses to them are still not completely clear and under investigation. Interestingly, some research has demonstrated the contribution of the gut microbiota, and its related metabolites (some of which can mimic the cardiac myosin), in cardiac inflammation and in the progression of this disease. They can stimulate a continuous and inadequate immune response, with a subsequent myocardial inflammatory damage. The aim of our review is to investigate the role of gut microbiota in myopericarditis, especially for the cardiovascular implications of COVID-19 viral infection, based on the idea that the modulation of gut microbiota can be a new frontier in the cardiological field to prevent or treat inflammatory cardiomyopathies.
Collapse
Affiliation(s)
- Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
- Correspondence:
| | - Sara Cicchinelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Laura Franza
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Federico Rosa
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Christian Zanza
- Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, Foundation Nuovo-Ospedale Alba-Bra, 12060 Verduno, Italy;
| | - Michele Cosimo Santoro
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy; (G.N.); (A.A.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy; (G.N.); (A.A.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| |
Collapse
|
19
|
Chilazi M, Duffy EY, Thakkar A, Michos ED. COVID and Cardiovascular Disease: What We Know in 2021. Curr Atheroscler Rep 2021; 23:37. [PMID: 33983522 PMCID: PMC8117457 DOI: 10.1007/s11883-021-00935-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Abstract
Purpose of Review Coronavirus disease 2019 (COVID-19) has been the cause of significant global morbidity and mortality. Here, we review the literature to date of the short-term and long-term consequences of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection on the heart. Recent Findings Early case reports described a spectrum of cardiovascular manifestations of COVID-19, including myocarditis, stress cardiomyopathy, myocardial infarction, and arrhythmia. However, in most cases, myocardial injury in COVID-19 appears to be predominantly mediated by the severity of critical illness rather than direct injury to myocardium from viral particles. While cardiac magnetic resonance imaging remains a powerful tool for diagnosing acute myocarditis, it should be used judiciously in light of low baseline prevalence of myocarditis. Guiding an athletic patient through return to play (RTP) after COVID-19 infection is a challenging process. More recent data show RTP has been a safe endeavor using a screening protocol. “Long COVID” or post-acute sequelae of SARS-CoV-2 infection has also been described. The reported symptoms span a large breadth of cardiopulmonary and neurologic complaints including fatigue, palpitations, chest pain, breathlessness, brain fog, and dysautonomia including postural tachycardia syndrome (POTS). Management of POTS/dysautonomia primarily centers on education, exercise, and salt and fluid repletion. Summary Our understanding of the impact of COVID-19 on the cardiovascular system is constantly evolving. As we enter a new age of survivorship, additional research is needed to catalogue the burden of persistent cardiopulmonary symptoms. Research is also needed to learn how acute management may alter the likelihood and prevalence of this chronic syndrome.
Collapse
Affiliation(s)
- Michael Chilazi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eamon Y Duffy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aarti Thakkar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. .,Division of Cardiology, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA.
| |
Collapse
|
20
|
Malik S, Naithani M, Mirza A, Darbari A, Saxena R. Possible mechanisms of cardiovascular complications and troponin elevation in coronavirus disease: A narrative review. HEART AND MIND 2021. [DOI: 10.4103/hm.hm_16_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
21
|
Jaiswal V, Sarfraz Z, Sarfraz A, Mukherjee D, Batra N, Hitawala G, Yaqoob S, Patel A, Agarwala P, Ruchika, Sarfraz M, Bano S, Azeem N, Naz S, Jaiswal A, Sharma P, Chaudhary G. COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review. J Prim Care Community Health 2021; 12:21501327211056800. [PMID: 34854348 PMCID: PMC8647231 DOI: 10.1177/21501327211056800] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND COVID-19 was initially considered to be a respiratory illness, but current findings suggest that SARS-CoV-2 is increasingly expressed in cardiac myocytes as well. COVID-19 may lead to cardiovascular injuries, resulting in myocarditis, with inflammation of the heart muscle. OBJECTIVE This systematic review collates current evidence about demographics, symptomatology, diagnostic, and clinical outcomes of COVID-19 infected patients with myocarditis. METHODS In accordance with PRISMA 2020 guidelines, a systematic search was conducted using PubMed, Cochrane Central, Web of Science and Google Scholar until August, 2021. A combination of the following keywords was used: SARS-CoV-2, COVID-19, myocarditis. Cohorts and case reports that comprised of patients with confirmed myocarditis due to COVID-19 infection, aged >18 years were included. The findings were tabulated and subsequently synthesized. RESULTS In total, 54 case reports and 5 cohorts were identified comprising 215 patients. Hypertension (51.7%), diabetes mellitus type 2 (46.4%), cardiac comorbidities (14.6%) were the 3 most reported comorbidities. Majority of the patients presented with cough (61.9%), fever (60.4%), shortness of breath (53.2%), and chest pain (43.9%). Inflammatory markers were raised in 97.8% patients, whereas cardiac markers were elevated in 94.8% of the included patients. On noting radiographic findings, cardiomegaly (32.5%) was the most common finding. Electrocardiography testing obtained ST segment elevation among 44.8% patients and T wave inversion in 7.3% of the sample. Cardiovascular magnetic resonance imaging yielded 83.3% patients with myocardial edema, with late gadolinium enhancement in 63.9% patients. In hospital management consisted of azithromycin (25.5%), methylprednisolone/steroids (8.5%), and other standard care treatments for COVID-19. The most common in-hospital complication included acute respiratory distress syndrome (66.4%) and cardiogenic shock (14%). On last follow up, 64.7% of the patients survived, whereas 31.8% patients did not survive, and 3.5% were in the critical care unit. CONCLUSION It is essential to demarcate COVID-19 infection and myocarditis presentations due to the heightened risk of death among patients contracting both myocardial inflammation and ARDS. With a multitude of diagnostic and treatment options available for COVID-19 and myocarditis, patients that are under high risk of suspicion for COVID-19 induced myocarditis must be appropriately diagnosed and treated to curb co-infections.
Collapse
Affiliation(s)
| | | | | | | | - Nitya Batra
- Maulana Azad Medical College, New
Delhi, India
| | | | - Sadia Yaqoob
- Jinnah Medical and Dental College,
Karachi, Pakistan
| | | | | | - Ruchika
- JJM Medical college, Davangere,
India
| | | | - Shehar Bano
- Fatima Jinnah Medical University,
Lahore, Pakistan
| | | | - Sidra Naz
- Harvard Medical School, Boston, MA,
USA
| | - Akash Jaiswal
- All India Institute of Medical
Science, New Delhi, India
| | | | | |
Collapse
|