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Coronavirus-induced myocarditis: A meta-summary of cases.
Heart Lung. 2020 Nov - Dec; 49(6):681-685.HL

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.

Authors+Show Affiliations

School of Clinical Medicine, University of Cambridge, United Kingdom.Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: ching_hui_sia@nuhs.edu.sg.Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32861884

Citation

Ho, Jamie Sy, et al. "Coronavirus-induced Myocarditis: a Meta-summary of Cases." Heart & Lung : the Journal of Critical Care, vol. 49, no. 6, 2020, pp. 681-685.
Ho JS, Sia CH, Chan MY, et al. Coronavirus-induced myocarditis: A meta-summary of cases. Heart Lung. 2020;49(6):681-685.
Ho, J. S., Sia, C. H., Chan, M. Y., Lin, W., & Wong, R. C. (2020). Coronavirus-induced myocarditis: A meta-summary of cases. Heart & Lung : the Journal of Critical Care, 49(6), 681-685. https://doi.org/10.1016/j.hrtlng.2020.08.013
Ho JS, et al. Coronavirus-induced Myocarditis: a Meta-summary of Cases. Heart Lung. 2020 Nov - Dec;49(6):681-685. PubMed PMID: 32861884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronavirus-induced myocarditis: A meta-summary of cases. AU - Ho,Jamie Sy, AU - Sia,Ching-Hui, AU - Chan,Mark Yy, AU - Lin,Weiqin, AU - Wong,Raymond Cc, Y1 - 2020/08/20/ PY - 2020/06/15/received PY - 2020/07/16/revised PY - 2020/08/18/accepted PY - 2020/8/31/pubmed PY - 2020/12/1/medline PY - 2020/8/31/entrez KW - COVID-19 KW - Coronavirus KW - Meta-summary KW - Myocarditis SP - 681 EP - 685 JF - Heart & lung : the journal of critical care JO - Heart Lung VL - 49 IS - 6 N2 - 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. SN - 1527-3288 UR - https://www.unboundmedicine.com/medline/citation/32861884/Coronavirus_induced_myocarditis:_A_meta_summary_of_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0147-9563(20)30356-3 DB - PRIME DP - Unbound Medicine ER -