Systematic Review of COVID-19 Related Myocarditis: Insights on Management and Outcome

Abstract

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as COVID-19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID-19 are widely variable and range from asymptomatic infection to multi-organ failure and death. Like other viral illnesses, acute myocarditis has been reported to be associated with COVID-19 infection. However, guidelines for the diagnosis of COVID-19 myocarditis have not been established. Methods Using a combination of search terms in the PubMed/Medline, Ovid Medline and the Cochrane Library databases and manual searches on Google Scholar and the bibliographies of articles identified, we reviewed all cases reported in the English language citing myocarditis associated with COVID-19 infection. Results Fourteen records comprising a total of fourteen cases that report myocarditis/myopericarditis secondary to COVID-19 infection were identified. There was a male predominance (58%), with the median age of the cases described being 50.4 years. The majority of patients did not have a previously identified comorbid condition (50%), but of those with a past medical history, hypertension was most prevalent (33%). Electrocardiogram findings were variable, and troponin was elevated in 91% of cases. Echocardiography was performed in 83% of cases reduced function was identified in 60%. Endotracheal intubation was performed in the majority of cases. Glucocorticoids were most commonly used in treatment of myocarditis (58%). Majority of patients survived to discharge (81%) and 85% of those that received steroids survived to discharge. Conclusion Guidelines for diagnosis and management of COVID-19 myocarditis have not been established and our knowledge on management is rapidly changing. The use of glucocorticoids and other agents including IL-6 inhibitors, IVIG and colchicine in COVID-19 myocarditis is debatable. In our review, there appears to be favorable outcomes related to myocarditis treated with steroid therapy. However, until larger scale studies are conducted, treatment approaches have to be made on an individualized case-by-case basis.

Myocarditis in COVID-19 patients: current problems

“…Sawalha et al [ 15 ] identified a total of 14 cases with myocarditis/myopericarditis believed to have occurred secondary to COVID-19 infection from December 1st 2019 to June 30th 2020. There was a male predominance (58%), with the median age of 50.4 years.…”

“…Regarding the diagnostic work-up for coronary artery disease, the report of Sawalha et al [ 15 ] included CCT (17% of cases) and invasive coronary angiography (25% of cases). No patients were found to have any obstructive coronary disease.…”

“…Cardiac magnetic resonance was performed in 43% of cases in the report of Sawalha et al [ 15 ] and showed diffuse late gadolinium enhancement (LGE). In the patients of Karyianna et al [ 16 ] CMR revealed LGE in all of the patients, while myocardial edema was identified in more than half of the images.…”

“…Information can be extracted from the reviews mentioned above. In the review of Sawalha et al [ 15 ], the majority of patients had survived to discharge (81% of those with reported outcomes) with only a minority of cases not surviving (19% of those with reported outcomes). All of the patients that reportedly passed away were noted to have both acute respiratory distress syndrome and myocarditis.…”

Initial Single-Center ST-Segment Elevation Myocardial Infarction Experience in New York Before and During the COVID-19 Pandemic

“…Furthermore, COVID-19 has demonstrated deleterious effects on the cardiovascular system in patients with and without preexisting cardiovascular disease. Cardiovascular involvement has been shown to be a negative prognostic factor in these patients [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. Furthermore, the pandemic appeared to decrease ST-elevation myocardial infarction (STEMI) presentations in the initial phases globally [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] ].…”