Fulminant Myocarditis: Covid Or Not COVID? Reinfection Or co-infection?

Yeleti, Ramya; Guglin, Maya; Saleem, Kashif; Adigopula, Sasikanth; Sinha, Anjan; Upadhyay, Smrity; Everett, Jeffrey E.; Ballut, Kareem; Uppuluri, Sarada; Rao, Roopa A.

doi:10.2217/fca-2020-0237

Cited by 12 publications

(13 citation statements)

References 10 publications

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“…We reported a case of fulminant myocarditis, confirmed by CMR, in a young COVID-19-positive patient. Should we have not sent the sample for a viral genome, we would have little doubt that the myocarditis was due to COVID-19; however, the genome test returned positive for parvovirus [21]. This observation is not unique.…”

Section: Discussionmentioning

confidence: 92%

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

et al. 2021

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Myocardial injury, diagnosed by troponin elevation, is common in COVID-19 patients, but cardiac involvement with clinical manifestations occurs less frequently. We analyzed the literature on COVID-19 (2020) and systematically reviewed the cases where individual patient data were presented. We searched PubMed and Google Scholar for "COVID," "COVID-19," and "coronavirus" in combination with "myocarditis," "heart failure," "takotsubo," "cardiomyopathy," and "cardiogenic shock." We identified 90 cases of COVID-19 with myocardial involvement, mean age 52.9 ± 18.3 years, 54.5% males. Of them, 55 survived (61.1%), 20 died (22.2%), and in 15 (16.7%) the outcome was unknown at the time of publication. Among patients with known outcome, mortality was 26%. The nadir LVEF was 31.7 ± 13.1% and recovered to 50.1 ± 16.0%. Pericardial effusion was a common finding, reported in 21 (23.3%) of patients, including moderate size effusion in 8.9% and large in 7.8%. The effusion caused tamponade in 11 (12.2%) of patients. Out of 83 patients who experienced a decrease in LVEF, 30 could be classified as takotsubo syndrome. The takotsubo patients were older than those with myocarditis, and with relatively high proportion of males. About one third of the cases was complicated by cardiogenic shock. Myocardial involvement in COVID-19 patients most often presents as a new, rapid decrease in LVEF, although normal LVEF or takotsubo-like wall motion pattern does not rule out myocarditis. Moderate and large pericardial effusion is common, and cardiac tamponade occurs in 12.2% of patients. Cardiogenic shock develops in one third of the patients. Mortality appears to be high at 26%.

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Section: Discussionmentioning

confidence: 92%

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

et al. 2021

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“…Indeed, the cardiac Society of Australia and New Zealand 94 and the American Society for Artificial Internal Organs 95 suggested that Impella could be considered for a selected subgroup of COVID‐19 patients suffering acute cardiac failure without severe respiratory failure (Table 4). However, few clinical reports are now emerging regarding the use of this device, and they indicate that Impella alone might not be enough to support these patients often affected by biventricular failure and hypoxia 72,75,78 . Contrarily, it seems more effective as left ventricular unloading combined with V‐A ECLS 72,75,77,78 or circulatory support associated with V‐V ECLS 72 …”

Section: Discussionmentioning

confidence: 99%

Temporary mechanical circulatory support for COVID‐19 patients: A systematic review of literature

et al. 2022

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Objective Myocardial damage occurs in up to 25% of coronavirus disease 2019 (COVID‐19) cases. While veno‐venous extracorporeal life support (V‐V ECLS) is used as respiratory support, mechanical circulatory support (MCS) may be required for severe cardiac dysfunction. This systematic review summarizes the available literature regarding MCS use rates, disease drivers for MCS initiation, and MCS outcomes in COVID‐19 patients. Methods PubMed/EMBASE were searched until October 14, 2021. Articles including adults receiving ECLS for COVID‐19 were included. The primary outcome was the rate of MCS use. Secondary outcomes included mortality at follow‐up, ECLS conversion rate, intubation‐to‐cannulation time, time on ECLS, cardiac diseases, use of inotropes, and vasopressors. Results Twenty‐eight observational studies (comprising both ECLS‐only populations and ECLS patients as part of larger populations) included 4218 COVID‐19 patients (females: 28.8%; median age: 54.3 years, 95%CI: 50.7–57.8) of whom 2774 (65.8%) required ECLS with the majority (92.7%) on V‐V ECLS, 4.7% on veno‐arterial ECLS and/or Impella, and 2.6% on other ECLS. Acute heart failure, cardiogenic shock, and cardiac arrest were reported in 7.8%, 9.7%, and 6.6% of patients, respectively. Vasopressors were used in 37.2%. Overall, 3.1% of patients required an ECLS change from V‐V ECLS to MCS for heart failure, myocarditis, or myocardial infarction. The median ECLS duration was 15.9 days (95%CI: 13.9–16.3), with an overall survival of 54.6% and 28.1% in V‐V ECLS and MCS patients. One study reported 61.1% survival with oxy‐right ventricular assist device. Conclusion MCS use for cardiocirculatory compromise has been reported in 7.3% of COVID‐19 patients requiring ECLS, which is a lower percentage compared to the incidence of any severe cardiocirculatory complication. Based on the poor survival rates, further investigations are warranted to establish the most appropriated indications and timing for MCS in COVID‐19.

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“…There are numerous indications for a contribution of B19V co-infections for the progression to myocardial injury. Thus, B19V-induced cardiac damage could be enhanced by coinfection with other viral species, such as HHV6, influenza or even SARS-CoV-2 [109][110][111][112]. For instance, a recent autopsy report from a 5-year-old girl revealed that co-infection of myocardial B19V with respiratory influenza virus can cause fulminant myocarditis and pneumonia [109].…”

Section: Erythroparvovirusmentioning

confidence: 99%

“…Importantly, SARS-CoV-2 might also play a role in the pathogenesis of autoimmune myocarditis. Co-infection of SARS-CoV-2 and B19V is furthermore suggested to trigger the immune cascade resulting in fulminant myocarditis [110].…”

Section: Sars-cov-2mentioning

confidence: 99%

Viral Myocarditis—From Pathophysiology to Treatment

Schultheiss

Baumeier

Aleshcheva

et al. 2021

JCM

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The diagnosis of acute and chronic myocarditis remains a challenge for clinicians. Characterization of this disease has been hampered by its diverse etiologies and heterogeneous clinical presentations. Most cases of myocarditis are caused by infectious agents. Despite successful research in the last few years, the pathophysiology of viral myocarditis and its sequelae leading to severe heart failure with a poor prognosis is not fully understood and represents a significant public health issue globally. Most likely, at a certain point, besides viral persistence, several etiological types merge into a common pathogenic autoimmune process leading to chronic inflammation and tissue remodeling, ultimately resulting in the clinical phenotype of dilated cardiomyopathy. Understanding the underlying molecular mechanisms is necessary to assess the prognosis of patients and is fundamental to appropriate specific and personalized therapeutic strategies. To reach this clinical prerequisite, there is the need for advanced diagnostic tools, including an endomyocardial biopsy and guidelines to optimize the management of this disease. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has currently led to the worst pandemic in a century and has awakened a special sensitivity throughout the world to viral infections. This work aims to summarize the pathophysiology of viral myocarditis, advanced diagnostic methods and the current state of treatment options.

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Fulminant Myocarditis: Covid Or Not COVID? Reinfection Or co-infection?

Cited by 12 publications

References 10 publications

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

Temporary mechanical circulatory support for COVID‐19 patients: A systematic review of literature

Viral Myocarditis—From Pathophysiology to Treatment

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