A Systematic Review of COVID - 19 Induced Myocarditis - Symptomatology, Prognosis, and Clinical Findings

Abstract

Authors: Vikash Jaiswal, Shavy Nagpal, Christine Angela E.Labitag, Janelle Tayo, Abhinav Patel, Kevin Bryan Lo, Rupalakshmi Vijayan, Wanessa F Matos, Sadia Yaqoob, Priyanka Panday, Saloni Savani, Zeinab Alnahas, Arushee Bhatnagar, Yoandra Diaz, John R. Dylewski, Own Khraisat, Mohammed JM Ghanim. Objective: With the advent of a novel coronavirus in December 2019, several case studies have reported its adversity on cardiac cells. We conducted a systematic review that describes the symptomatology, prognosis, and clinical findings of patients with COVID-19-related myocarditis. Methods: Search engines including PubMed, Google Scholar, Cochrane Central, and Web of Science were queried for "SARS-CoV-2" or "COVID 19" and "myocarditis." PRISMA guidelines were employed, and peerreviewed journals in English related to COVID- 19 were included. Results: This systematic review included 22 studies and 37 patients. Eight patients (36%) were confirmed myocarditis, while the rest were possible myocarditis. Most patients had elevated cardiac biomarkers, including troponin, CRP, CK, CK-MB, and NT-pro BNP. Electrocardiogram results noted tachycardia (47%), left ventricular hypertrophy (50%), ST-segment alterations (41%), and T wave inversion (18%). Echocardiography presented reduced LVEF (77%), left ventricle abnormalities (34%), right ventricle aberrations (12%), and pericardial effusion (71%). Further, CMR showed reduced myocardial edema (75%), non-ischemic patterns (50%), and hypokinesis (26%). The mortality was significant at 25%. Conclusions: Mortality associated with COVID-19 myocarditis appears significant but underestimated. Further studies are warranted to evaluate and quantify patients’ actual prognosis and outcomes with COVID-19 myocarditis.