New-onset myocardial injury in pregnant patients with coronavirus disease 2019: a case series of 15 patients

Abstract

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the new coronavirus responsible for the coronavirus disease (COVID-19), characterized by acute respiratory distress syndrome and atypical pneumonia. In non-pregnant women, studies have shown that SARS-CoV-2 causes cardiac injury, which can result in myocardial inflammation and damage. Despite many studies investigating the extent of cardiac compromise in severely ill COVID-19 patients, little is known regarding its impact on pregnant women. Objective To illustrate the clinical, laboratory, radiological findings, and outcomes of COVID-19 pregnant patients who developed myocardial injury with ventricular dysfunction. Study Design We retrospectively reviewed the paper records of fifteen pregnant women with COVID-19, who developed myocardial injury on a single tertiary care hospital in the Dominican Republic. Patient's baseline characteristics, clinical picture, laboratory, and radiological findings were presented, and maternal and fetal outcomes were analyzed. Results Of 154 pregnant patients diagnosed with COVID-19 at our hospital during the study period, 15 (9.7%), developed myocardial injury. These patients' mean age and gestational age were 29.87 ± 5.83 and 32.31 ± 3.68, respectively. 66.7% of patients presented with shortness of breath and 16.3% with palpitations. All patients were admitted to the intensive care unit, and 86.6% needed intubation. Patients developed myocardial injury confirmed with highly elevated troponin (34.6 [14.4-55.5 ng/ml]), and pro-BNP concentrations (209 [184-246 pg/ml]). Additionally, all patients developed left ventricular dysfunction demonstrated by an echocardiogram with a mean left ventricular ejection fraction (LVEF) of 37.67 ± 6.4 %. Two patients that presented with palpitations passed away a few days after admission. Conclusion Our study showed COVID-19 induced myocardial injury and left ventricular dysfunction in pregnant women with a 13.3% mortality rate which was attributed to malignant arrhythmias.

Intravenous immunoglobulin treatment for patients with severe COVID-19: a retrospective multicentre study

“…Myocardial injury was defined as an increase in troponin concentration above the 99 th percentile upper reference limit (>0.4 ng/ml) [ 25 , 26 ].…”

“…Immunosuppressive therapy refers to the use of immunosuppressive drugs, such as cytotoxic drugs administered to patients with active tumor, organ transplantation, or HIV, as well as cumulative use of corticosteroids for over three months [24]. Myocardial injury was defined as an increase in troponin concentration above the 99 th percentile upper reference limit (> 0.4 ng/ml) [25,26].…”

Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients

“…13e19 There is therefore an increased potential for maternal deaths, 20e23 especially in low-to middleincome countries. 24 There are also disparate accounts of an increase in premature births, 23,25e27 premature cesarean deliveries, 28 and myocardial injuries 29,30 in addition to an increased risk for preeclampsia, cesarean delivery, and perinatal death in pregnant women with COVID-19 infections. 31 When compared with COVID-19 infected, nonpregnant peers, symptomatic pregnant patients may be at an increased risk for a more severe COVID-19 disease course.…”

COVID-19 Disease During Pregnancy and Peripartum Period: A Cardiovascular Review

“…Mercedes et al represented a series of 154 pregnant women with COVID 19 infection, of whom 15 women became critically ill and were admitted to ICU. Decreased LVEF and elevated cardiac enzymes (pro-BNP and CTn I) were reported for all of these critically ill patients, with mortality rate of 13% (two patients) due to arrhythmia 38 . In a series of 31 pregnant women with positive SARS-COV 2 infection and severe disease, 22% of women with troponin measurement, had elevated values, as well as 30% of BNP measures.…”