ABSTRACT
Background: COVID-19-infection manifestations range from asymptomatic infection to multi-organ failure and death. Cardiovascular complications from COVID -19 include myocarditis, acute myocardial infarction, heart failure. Population-level data is lacking on the relationship between COVID-19 and cardiovascular complications. Objectives: To examine the incidence of myocarditis, acute myocardial infarction (AMI), heart failure (HF) after COVID-19 infection. Methods: We used a retrospective cohort study using deidentified data from 50 health systems across the United States. Cohort groups were created using patients ≥18, who were admitted to hospitals for respiratory illness with COVID in 2020 and respiratory illness without COVID-19 for the years 2020 and 2019. There were 107,699 patients with COVID;77,499 patients with respiratory illness in 2020, and 112,898 patients with respiratory illness in 2019. The COVID group was matched to each of the respiratory illness groups by propensity score. Patients with prior specific cardiovascular events were excluded for the correspondent outcome analysis. Our outcomes were: myocarditis, AMI, HF. Results: In the COVID-19 group, 79 patients had new-onset myocarditis compared to 29 patients in the non-COVID-19 control (Pneumonia/flu) group (OR 2.73, CI 95%, 1.78-4.18). In the COVID- 19 group, 1512 patients developed HF compared to 2,659 patients in the non-COVID-19 group, (OR 0.49, CI 95%, 0.46-0.52). 1125 patients in COVID-19 group had AMI compared to 1243 patients in non-COVID-19 group (OR 0.87, CI 95 %, 0.80-0.94). Conclusion: COVID-19 was associated with a high risk of incident myocarditis but unexpectedly lower rates of HF diagnosis, suggesting possible under testing (e.g., 2-D ECHO) and underdiagnosis.
ABSTRACT
Introduction: COVID-19-infection caused by Severe Acute Respiratory Syndrome Coronavirus-2- has protean manifestations ranging from asymptomatic infection to multi-organ failure and death. Cardiovascular complications from COVID-19 include myocarditis, acute myocardial infarction (AMI), heart failure (HF). These complications-captured clinically and by tests (troponins, 2-D ECHO, MRI)-can occur either by direct injury to the myo-pericardium or by an inflammatory response and cytokine storm. Population-level data is lacking on the relationship between COVID19 and onset of Myocarditis, AMI, and HF. Therefore, we examined the incidence and correlations of Myocarditis, AMI, and HF after COVID-19 infection across the United States using a large nationwide database. Hypothesis: Infection with COVID-19 is associated with an increased risk of myocarditis. Methods: We used a retrospective cohort study using de-identified data from 35 health systems across the United States. Cohort groups were created using patients ≥18, who were admitted to hospitals for respiratory illness with COVID in 2020 and respiratory illness without COVID-19 for the years 2020 and 2019. Patients with prior cardiovascular events were excluded from the study. There were 103,187 patients with COVID;77,242 patients with respiratory illness in 2020, and 114,908 patients with respiratory illness in 2019. The COVID group was matched to each of the respiratory illness groups by propensity score. Three main cardiovascular outcomes were studied: myocarditis, AMI, HF. Results: In the COVID-19 group, 79 patients had new-onset myocarditis compared to 29 patients in the non-COVID-19 control group (Odds ratio [OR] 2.73, CI 95%, 1.78-4.18). In the COVID-19 group, 1512 patients developed HF compared to 2,659 patients in the non-COVID-19 group, (OR 0.49, CI 95%, 0.46-0.52). 1125 patients in COVID-19 group had AMI compared to 1243 patients in nonCOVID-19 group (OR 0.87, CI 95 %, 0.80-0.94). Conclusions: COVID-19 patients had 2 to 3 times the odds of incident myocarditis compared to non-COVID controls. Unexpected findings were the lower rates of HF diagnoses in the COVID-19 group, suggesting possible under testing (e.g., 2-D ECHO) and underdiagnosis in isolated COVID patients.