Incidence of infective endocarditis during the coronavirus disease 2019 pandemic: A nationwide study

Havers-Borgersen, Eva; Fosbøl, Emil Loldrup; Butt, Jawad H; Petersen, Jørn Henrik; Dalsgaard, Andreas Engelbredt; Kyhl, Frederik; Schou, Morten; Phelps, Matthew; Kragholm, Kristian; Gislason, Gunnar; Torp‐Pedersen, Christian; Køber, Lars; Østergaard, Lauge

doi:10.1016/j.ijcha.2020.100675

Cited by 11 publications

(9 citation statements)

References 28 publications

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“… 39 A Danish nationwide study of infective endocarditis (IE) hospitalizations found no difference during the pandemic, whereas a Mexican single-centre study showed a 93% reduction. 40 , 41 One single-centre study reported a decline in hospitalizations with adult congenital heart disease (ACHD) during the pandemic, 42 and two studies demonstrated a significant increase in the incidence of stress cardiomyopathy. 43 , 44 …”

Section: Resultsmentioning

confidence: 99%

The collateral damage of COVID-19 to cardiovascular services: a meta-analysis

Nadarajah

Hurdus

et al. 2022

European Heart Journal

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Aims The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. Methods and results From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66–0.94) and revascularisation (RR 0.73, 95% CI 0.62–0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10–1.37) and heart failure (RR 1.08, 95% CI 1.04–1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. Conclusions There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.

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Section: Resultsmentioning

confidence: 99%

The collateral damage of COVID-19 to cardiovascular services: a meta-analysis

Nadarajah

Hurdus

et al. 2022

European Heart Journal

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“…В целом, пока не выявлено нарастания частоты ИЭ в период пандемии COVID-19 [33]. Однако в этих условиях диагностика ИЭ затягивается ввиду необходимости дифференциальной диагностики с COVID-19 и обусловленных этим сложностей с госпитализацией [34].…”

Section: Discussionunclassified

Subacute and chronic post-covid myoendocarditis: clinical presentation, role of coronavirus persistence and autoimmune mechanisms

et al. 2021

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Aim To study clinical features of myoendocarditis and its possible mechanisms, including persistence of SARS-Cov-2 in the myocardium, in the long-term period following COVID-19.Material and methods This cohort, prospective study included 15 patients aged 47.8±13.4 years (8 men) with post-COVID myocarditis. The COVID-19 diagnosis was confirmed for all patients. Median time to seeking medical care after COVID-19 was 4 [3; 7] months. The diagnosis of myocarditis was confirmed by magnetic resonance imaging (MRI) of the heart (n=10) and by endomyocardial biopsy of the right ventricle (n=6). The virus was detected in the myocardium with PCR; immunohistochemical (IHC) study with antibody to SARS-Cov-2 was performed; anticardiac antibody level was measured; and echocardiography and Holter monitoring were performed. Hemodynamically significant coronary atherosclerosis was excluded for all patients older than 40 years.Results All patients showed a clear connection between the emergence or exacerbation of cardiac symptoms and COVID-19. 11 patients did not have any signs of heart disease before COVID-19; 4 patients had previously had moderate arrhythmia or heart failure (HF) without myocarditis. Symptoms of myocarditis emerged at 1–5 months following COVID-19. MRI revealed typical late gadolinium accumulation, signs of hyperemia, and one case of edema. The level of anticardiac antibodies was increased 3-4 times in 73 % больных. Two major clinical variants of post-COVID myocarditis were observed. 1. Arrhythmic (n=6), with newly developed extrasystole or atrial fibrillation without systolic dysfunction. 2. Decompensated variant with systolic dysfunction and biventricular HF (n=9). Mean left ventricular ejection fraction was 34.1±7.8 %, and left ventricular end-diastolic dimension was 5.8±0.7 cm. In one case, myocarditis was associated with signs of IgG4‑negative aortitis. SARS-Cov-2 RNA was found in 5 of 6 biopsy samples of the myocardium. The longest duration of SARS-Cov-2 persistence in the myocardium was 9 months following COVID-19. By using antibody to the Spike antigen and nucleocapsid, SARS-Cov-2 was detected in cardiomyocytes, endothelium, and macrophages. Five patients were diagnosed with lymphocytic myocarditis; one with giant-cell myocarditis; three patients had signs of endocarditis (infectious, lymphocytic with mural thrombosis).Conclusion Subacute/chronic post-COVID myocarditis with isolated arrhythmias or systolic dysfunction is characterized by long-term (up to 9 months) persistence of SARS-Cov-2 in the myocardium in combination with a high immune activity. Endocarditis can manifest either as infectious or as nonbacterial thromboendocarditis. A possibility of using corticosteroids and anticoagulants in the treatment of post-COVID myoendocarditis should be studied.

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“…These contributing factors could ultimately lead to the development of IE. However, it should be noted that researchers from Denmark reported no significant difference in overall IE incidence during the first six months of the 2020 COVID-19 pandemic [26]. The association between COVID-19, IE, and opioid use remains an unanswered question.…”

Section: Covid-19 and Iementioning

confidence: 99%

The Risk of Infective Endocarditis among COVID-19 Patients with Non-Medical Opioid Use

Wiener¹,

Waters²,

Bambrick³

et al. 2021

JICOA

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Patients with opioid use disorder are more likely to get coronavirus disease 2019 (COVID-19). Cardiovascular diseases frequently present in COVID-19 patients and can increase their susceptibility to invasive infectious diseases, such as infective endocarditis (IE). This study examines the difference in IE incidence following COVID-19 diagnosis between individuals with and without non-medical opioid use. De-identified electronic medical records data were retrieved from TriNetX, a web-based database. Patients in the U.S., aged 18-60 years, with a diagnosis of COVID-19 during January 2020 - January 2021 were included in this study. Development of IE was determined within three months after COVID-19 diagnosis. Logistic regression was conducted to estimate the risk of developing IE between COVID-19 patients with and without opioid use after propensity score matching. COVID-19 patients with non-medical opioid use had 6.8 times the risk of developing IE compared with COVID-19 patients without opioid use (95% CI: 5.44, 8.56; p<0.0001) after propensity score matching. Findings suggest a significant risk of IE among COVID-19 patients with a history of non-medical opioid use. It provides objective evidence to account for baseline opioid use in the risk assessment of IE among COVID-19 patients.

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Incidence of infective endocarditis during the coronavirus disease 2019 pandemic: A nationwide study

Abstract: Highlights The incidence of IE during lockdown was 11.1 IE cases per 100,000 PY. No reduction in the incidence of IE during the lockdown compared to preceding years. No difference in the incidence of IE pre- versus post-lockdown in 2020.

Cited by 11 publications

References 28 publications

The collateral damage of COVID-19 to cardiovascular services: a meta-analysis

The collateral damage of COVID-19 to cardiovascular services: a meta-analysis

Subacute and chronic post-covid myoendocarditis: clinical presentation, role of coronavirus persistence and autoimmune mechanisms

The Risk of Infective Endocarditis among COVID-19 Patients with Non-Medical Opioid Use

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