Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis
E. Ammirati
(1)
,
L. Lupi
(2)
,
M. Palazzini
(1)
,
N. S. Hendren
(3)
,
J. L. Grodin
(3)
,
C. V. Cannistraci
(4, 5)
,
M. Schmidt
(6)
,
G. Hekimian
(6)
,
G. Peretto
(7)
,
T. Bochaton
(8, 9)
,
A. Hayek
(10, 9)
,
N. Piriou
(11)
,
S. Leonardi
(12, 13)
,
S. Guida
(12, 13)
,
A. Turco
(12, 13)
,
S. Sala
(7)
,
A. Uribarri
(14, 15)
,
C. M. van De Heyning
(16)
,
M. Mapelli
(17, 17, 18)
,
J. Campodonico
(17, 17, 18)
,
P. Pedrotti
(1)
,
M. I. Barrionuevo Sánchez
(19)
,
A. Ariza Sole
(19)
,
M. Marini
(20)
,
M. V. Matassini
(20)
,
M. Vourc'H
(21, 22, 23)
,
A. Cannatà
(24, 25)
,
D. I. Bromage
(24, 25)
,
D. Briguglia
(26)
,
J. Salamanca
(27)
,
P. Diez-Villanueva
(27)
,
J. Lehtonen
(28)
,
F. Huang
(29)
,
S. Russel
(29)
,
F. Soriano
(1)
,
F. Turrini
(30)
,
M. Cipriani
(1)
,
M. Bramerio
(1)
,
M. Di Pasquale
(2)
,
A. Grosu
(31)
,
M. Senni
(31)
,
D. Farina
(2)
,
P. Agostoni
(17, 17, 18)
,
S. Rizzo
(32)
,
M. de Gaspari
(32)
,
F. Marzo
(33)
,
J. M. Duran
(34)
,
E. D. Adler
(34)
,
C. Giannattasio
(1, 35)
,
C. Basso
(32)
,
T. Mcdonagh
(24, 25)
,
M. Kerneïs
(6)
,
A. Combes
(6)
,
P. G. Camici
(7)
,
J. A. De Lemos
(3)
,
M. Metra
(2)
1
Niguarda Hospital [Milan, Italy]
2 UniBs - Università degli Studi di Brescia = University of Brescia
3 University of Texas Southwestern Medical Center [Dallas]
4 THU - Tsinghua University [Beijing]
5 CSBD - Center for Systems Biology Dresden [Dresden, Germany]
6 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
7 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
8 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
9 HCL - Hospices Civils de Lyon
10 UCBL - Université Claude Bernard Lyon 1
11 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
12 UNIPV - Università degli Studi di Pavia = University of Pavia
13 Fondazione IRCCS Policlinico San Matteo [Pavia]
14 HCUV - Hospital Clinico Universitario de Valladolid [Castilla y León, Spain]
15 ISC - Instituto de Salud Carlos III [Madrid]
16 UA - University of Antwerp
17 UNIMI - Università degli Studi di Milano = University of Milan
18 IRCCS Istituto Nazionale dei Tumori [Milano]
19 Bellvitge University Hospital = Bellvitge Hospital Universitari
20 POGSA-AHS - Presidio Ospedaliero "G. Salesi" AN = Ancona Hospital Salesi [Ancona, Italy]
21 Hôpital Guillaume-et-René-Laennec [Saint-Herblain]
22 CHU Nantes - Centre Hospitalier Universitaire de Nantes
23 EA 3826 - Thérapeutiques cliniques et expérimentales des infections (EA 3826)
24 King‘s College London
25 KCH - King's College Hospital
26 MD2H - Mater Domini Humanitas Hospital [Castellanza, Italy]
27 Hospital Universitario de La Princesa
28 HUS - Helsinki University Hospital [Finland]
29 Hôpital Foch [Suresnes]
30 OCB - Ospedale Civile di Baggiovara [Modena, Italy]
31 Hosp P Giovanni XXIII - Hospital Papa Giovanni XXIII
32 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
33 OIR - Ospedale "Infermi" di Rimini [Rimini, Italy]
34 UC San Diego - University of California [San Diego]
35 UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca
2 UniBs - Università degli Studi di Brescia = University of Brescia
3 University of Texas Southwestern Medical Center [Dallas]
4 THU - Tsinghua University [Beijing]
5 CSBD - Center for Systems Biology Dresden [Dresden, Germany]
6 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
7 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
8 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
9 HCL - Hospices Civils de Lyon
10 UCBL - Université Claude Bernard Lyon 1
11 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
12 UNIPV - Università degli Studi di Pavia = University of Pavia
13 Fondazione IRCCS Policlinico San Matteo [Pavia]
14 HCUV - Hospital Clinico Universitario de Valladolid [Castilla y León, Spain]
15 ISC - Instituto de Salud Carlos III [Madrid]
16 UA - University of Antwerp
17 UNIMI - Università degli Studi di Milano = University of Milan
18 IRCCS Istituto Nazionale dei Tumori [Milano]
19 Bellvitge University Hospital = Bellvitge Hospital Universitari
20 POGSA-AHS - Presidio Ospedaliero "G. Salesi" AN = Ancona Hospital Salesi [Ancona, Italy]
21 Hôpital Guillaume-et-René-Laennec [Saint-Herblain]
22 CHU Nantes - Centre Hospitalier Universitaire de Nantes
23 EA 3826 - Thérapeutiques cliniques et expérimentales des infections (EA 3826)
24 King‘s College London
25 KCH - King's College Hospital
26 MD2H - Mater Domini Humanitas Hospital [Castellanza, Italy]
27 Hospital Universitario de La Princesa
28 HUS - Helsinki University Hospital [Finland]
29 Hôpital Foch [Suresnes]
30 OCB - Ospedale Civile di Baggiovara [Modena, Italy]
31 Hosp P Giovanni XXIII - Hospital Papa Giovanni XXIII
32 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
33 OIR - Ospedale "Infermi" di Rimini [Rimini, Italy]
34 UC San Diego - University of California [San Diego]
35 UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca
Résumé
BACKGROUND: 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. METHODS: 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. RESULTS: 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 (P=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; P\textless0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). CONCLUSIONS: 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.
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