COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review

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.

Lipocalin-2, S100A8/A9, and cystatin C: Potential predictive biomarkers of cardiovascular complications in COVID-19

“…31 Cardiac injury is reported in hospitalized severe COVID-19 patients and is strongly associated with poor clinical outcomes. 32,33 Hence, assessment of the level of LCN2, S100A8/ A9, and CST3 in moderate and severe COVID-19 patients is important. Moreover, the correlation between the levels of said inflammatory markers and cardiac injury is the utmost requirement to establish their potential roles in the cardiorenal complication observed in severe COVID-19.…”

Symptomatology, prognosis and clinical findings of STEMI as a ramification of COVID-19: A systematic review and proportion meta-analysis

“…Since the beginning of the pandemic, a wide spectrum of myocardial injury patterns have been associated with increasing cardiovascular morbidity and mortality [ 1 , 2 ]. These have been associated with direct myocardial injury as well as indirect effect on myocardium through stress induced injury [ 3 ].…”

Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Systematic Review

“…Secondly, the type of studies reviewed (case reports and case series) are inherently limited and considered to possess a lower level of evidence compared to those acquired from larger clinical studies, limiting the inferences that could be gathered from such studies. 24 , 25 …”