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1.
J Cardiovasc Magn Reson ; 23(1): 140, 2021 12 30.
Article in English | MEDLINE | ID: covidwho-1590893

ABSTRACT

BACKGROUND: Recent evidence shows an association between coronavirus disease 2019 (COVID-19) infection and a severe inflammatory syndrome in children. Cardiovascular magnetic resonance (CMR) data about myocardial injury in children are limited to small cohorts. The aim of this multicenter, international registry is to describe clinical and cardiac characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 using CMR so as to better understand the real extent of myocardial damage in this vulnerable cohort. METHODS AND RESULTS: Hundred-eleven patients meeting the World Health Organization criteria for MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having clinical cardiac involvement and having received CMR imaging scan were included from 17 centers. Median age at disease onset was 10.0 years (IQR 7.0-13.8). The majority of children had COVID-19 serology positive (98%) with 27% of children still having both, positive serology and polymerase chain reaction (PCR). CMR was performed at a median of 28 days (19-47) after onset of symptoms. Twenty out of 111 (18%) patients had CMR criteria for acute myocarditis (as defined by the Lake Louise Criteria) with 18/20 showing subepicardial late gadolinium enhancement (LGE). CMR myocarditis was significantly associated with New York Heart Association class IV (p = 0.005, OR 6.56 (95%-CI 1.87-23.00)) and the need for mechanical support (p = 0.039, OR 4.98 (95%-CI 1.18-21.02)). At discharge, 11/111 (10%) patients still had left ventricular systolic dysfunction. CONCLUSION: No CMR evidence of myocardial damage was found in most of our MIS-C cohort. Nevertheless, acute myocarditis is a possible manifestation of MIS-C associated with SARS-CoV-2 with CMR evidence of myocardial necrosis in 18% of our cohort. CMR may be an important diagnostic tool to identify a subset of patients at risk for cardiac sequelae and more prone to myocardial damage. CLINICAL TRIAL REGISTRATION: The study has been registered on ClinicalTrials.gov, Identifier NCT04455347, registered on 01/07/2020, retrospectively registered.


Subject(s)
COVID-19 , Myocarditis , COVID-19/complications , Child , Contrast Media , Gadolinium , Humans , Magnetic Resonance Spectroscopy , Myocarditis/diagnostic imaging , Myocarditis/epidemiology , Predictive Value of Tests , Registries , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
2.
Magn Reson Imaging ; 84: 132-134, 2021 12.
Article in English | MEDLINE | ID: covidwho-1506958

ABSTRACT

Perimyocarditis is a well-known acute inflammation of the pericardium and the underlying myocardium. Most commonly perimyocarditis is of viral aetiology, specifically the coxsackie B virus. However, nowadays SARS-CoV-2 associated with COVID-19 infections has emerged as a potential rare cause of perimyocarditis. This case report will demonstrate a case of a young female with perimyocarditis as diagnosed by magnetic resonance imaging (MRI) accompanied by antigens indicating a past COVID-19 infection. Clinical status as well as Findings at MRI, echocardiography and lab results will be reviewed.


Subject(s)
COVID-19 , Myocarditis , Echocardiography , Female , Humans , Myocarditis/diagnostic imaging , Myocardium , SARS-CoV-2
3.
J Korean Med Sci ; 36(39): e277, 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1463460

ABSTRACT

Mass vaccination with the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine (BNT162b2) in Korea has resulted in many reported adverse effects. These side effects are the object of much scrutiny in the medical community. We report the case of a 29-year-old male who was diagnosed with myopericarditis after his second dose of Pfizer-BioNTech COVID-19 vaccine. This patient is the second recognized case of Pfizer-BioNTech COVID-19 vaccine induced myopericarditis in Korea and the first to have recovered from it. He originally presented with chest discomfort and exertional chest pain. Lab tests revealed elevated cardiac marker levels and echocardiographic findings displayed minimal pericardial effusion, prompting diagnosis as myopericarditis. We decided on two weeks of outpatient treatment with non-steroidal anti-inflammatory drugs (NSAIDs) due to the patient's mild symptoms and his occupation in the military. When this proved insufficient, we shifted to combination therapy with low dose corticosteroids and NSAIDs. After two weeks of treatment, the patient's symptoms and pericardial effusion had improved, and he was recovered completely 37 days after the onset.


Subject(s)
COVID-19 Vaccines/adverse effects , Myocarditis/etiology , Vaccination/adverse effects , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Echocardiography , Humans , Male , Myocarditis/diagnostic imaging , Myocarditis/drug therapy
4.
J Cardiovasc Magn Reson ; 23(1): 106, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1455983

ABSTRACT

BACKGROUND: Myocarditis is a potential complication after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and a known cause of sudden cardiac death. Given the athletic demands of soldiers, identification of myocarditis and characterization of post-acute sequelae of SARS-CoV-2 infection with cardiovascular symptoms (CV PASC) may be critical to guide return-to-service. This study sought to evaluate the spectrum of cardiac involvement among soldiers with cardiopulmonary symptoms in the late convalescent phase of recovery from SARS-CoV-2 compared to a healthy soldier control group, and to determine the rate of progression to CV PASC. METHODS: All soldiers referred for cardiovascular magnetic resonance (CMR) imaging for cardiopulmonary symptoms following COVID-19 were enrolled and matched by age, gender, and athletic phenotype 1:1 to soldiers undergoing CMR in the year prior to the first case of COVID-19 at our institution. Demographic, clinical, laboratory, and imaging parameters were compared between groups. The diagnosis of acute myocarditis was made using modified Lake Louise criteria. Wilcoxon rank sum and chi-squared tests were used for comparison of continuous and categorical variables, respectively. RESULTS: Fifty soldier cases and 50 healthy soldier controls were included. The median time from SARS-CoV-2 detection to CMR was 71 days. The majority of cases experienced moderate symptoms (N = 43, 86%), while only 10% required hospitalization. The right ventricular (RV) ejection fraction (RVEF) was reduced in soldier cases compared to controls (51.0% vs. 53.2%, p = 0.012). Four cases were diagnosed with myocarditis (8%), 1 (2%) was diagnosed with Takotsubo cardiomyopathy, and 1 (2%) had new biventricular systolic dysfunction of unclear etiology. Isolated inferior RV septal insertion late gadolinium enhancement (LGE) was present in 8 cases and 8 controls (16% vs. 24%, p = 0.09). Seven of the 19 (37%) cases that completed an intermediate-term follow-up survey reported CV PASC at a median of 139 days of follow-up. Two of the 7 soldiers (29%) with CV PASC had a pathological clinical diagnosis (myocarditis) on CMR. CONCLUSIONS: Cardiovascular pathology was diagnosed in 6 symptomatic soldiers (12%) after recovery from SARS-CoV-2, with myocarditis found in 4 (8%). RVEF was reduced in soldier cases compared to controls. CV PASC occurred in over one-third of soldiers surveyed, but did not occur in any soldiers with asymptomatic acute SARS-CoV-2 infection.


Subject(s)
COVID-19 , Military Personnel , Myocarditis , COVID-19/complications , Case-Control Studies , Contrast Media , Gadolinium , Humans , Magnetic Resonance Spectroscopy , Myocarditis/diagnostic imaging , Myocarditis/etiology , Predictive Value of Tests , SARS-CoV-2
5.
Radiologe ; 61(10): 896-901, 2021 Oct.
Article in German | MEDLINE | ID: covidwho-1411798

ABSTRACT

BACKGROUND: Infections with coronavirus disease 2019 (COVID-19) most frequently affect the lungs but may also result in cardiovascular involvement and cardiovascular complications. The heart can either be involved as part of a systemic infection or directly involved due to myocarditis or pericarditis as well as in hypoxia, volume overload, fever or thromboembolic complications. Moreover, pre-existing underlying cardiovascular diseases have a substantial influence on the prognosis of patients with COVID-19 infections. METHOD: This review article is based on a comprehensive literature search in the PubMed database on cardiac involvement and cardiac complications of COVID 19 infections, enriched by experiences in dealing with this disorder. RESULTS AND CONCLUSION: Depending on the severity of the infection, cardiac involvement in a COVID 19 infection is observed in up to 50% of the patients. Besides echocardiography as the first-line examination method, cardiac magnetic resonance imaging (MRI) for assessment of the myocardial structure and cardiac computed tomography (CT) for assessment of coronary arteries and to rule out intracardiac thrombus formation represent important imaging modalities. The most important cardiac manifestations in COVID 19 infections are ischemic and inflammatory diseases. The imaging diagnostics play an important role in the acute as well as in the postinfectious phases.


Subject(s)
COVID-19 , Heart Diseases , Myocarditis , Heart Diseases/diagnostic imaging , Humans , Magnetic Resonance Imaging , Myocarditis/diagnostic imaging , SARS-CoV-2
6.
J Cardiovasc Magn Reson ; 23(1): 101, 2021 09 09.
Article in English | MEDLINE | ID: covidwho-1403241

ABSTRACT

BACKGROUND: Messenger RNA (mRNA) coronavirus disease of 2019 (COVID-19) vaccine are known to cause minor side effects at the injection site and mild global systemic symptoms in first 24-48 h. Recently published case series have reported a possible association between acute myocarditis and COVID-19 vaccination, predominantly in young males. METHODS: We report a case series of 5 young male patients with cardiovascular magnetic resonance (CMR)-confirmed acute myocarditis within 72 h after receiving a dose of an mRNA-based COVID-19 vaccine. RESULTS: Our case series suggests that myocarditis in this setting is characterized by myocardial edema and late gadolinium enhancement in the lateral wall of the left ventricular (LV) myocardium, reduced global LV longitudinal strain, and preserved LV ejection fraction. All patients in our series remained clinically stable during a relatively short inpatient hospital stay. CONCLUSIONS: In conjunction with other recently published case series and national vaccine safety surveillance data, this case series suggests a possible association between acute myocarditis and COVID-19 vaccination in young males and highlights a potential pattern in accompanying CMR abnormalities.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Magnetic Resonance Imaging, Cine/methods , Myocarditis/diagnostic imaging , Acute Disease , Adult , Heart/diagnostic imaging , Heart/physiopathology , Humans , Male , Myocarditis/physiopathology , Predictive Value of Tests , SARS-CoV-2 , Young Adult
7.
Clin Res Cardiol ; 109(12): 1549-1566, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1384407

ABSTRACT

BACKGROUND: Myocardial involvement induced by SARS-CoV-2 infection might be important for long-term prognosis. The aim of this observational study was to characterize the myocardial effects during SARS-CoV-2 infections by echocardiography. RESULTS AND METHODS: An extended echocardiographic image acquisition protocol was performed in 18 patients with SARS-CoV-2 infection assessing LV longitudinal, radial, and circumferential deformation including rotation, twist, and untwisting. Furthermore, LV deformation was analyzed in an age-matched control group of healthy individuals (n = 20). The most prevalent finding was a reduced longitudinal strain observed predominantly in more than one basal LV segment (n = 10/14 patients, 71%). This pattern reminded of a "reverse tako-tsubo" morphology that is not typical for other viral myocarditis. Additional findings included a biphasic pattern with maximum post-systolic or negative regional radial strain predominantly basal (n = 5/14 patients, 36%); the absence or dispersion of basal LV rotation (n = 6/14 patients, 43%); a reduced or positive regional circumferential strain in more than one segment (n = 7/14 patients, 50%); a net rotation showing late post-systolic twist or biphasic pattern (n = 8/14 patients, 57%); a net rotation showing polyphasic pattern and/or higher maximum net values during diastole (n = 8/14 patients, 57%). CONCLUSION: Myocardial involvement due to SARS-CoV-2-infection was highly prevalent in the present cohort-even in patients with mild symptoms. It appears to be characterized by specific speckle tracking deformation abnormalities in the basal LV segments. These data set the stage to prospectively test whether these parameters are helpful for risk stratification and for the long-term follow-up of these patients.


Subject(s)
COVID-19/complications , Echocardiography , Heart/diagnostic imaging , Myocarditis/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/virology , Case-Control Studies , Female , Heart/physiopathology , Heart/virology , Host-Pathogen Interactions , Humans , Male , Middle Aged , Myocarditis/physiopathology , Myocarditis/virology , Predictive Value of Tests , SARS-CoV-2/pathogenicity , Severity of Illness Index , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/virology , Ventricular Function, Left
8.
Clin Res Cardiol ; 110(11): 1832-1840, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1375633

ABSTRACT

OBJECTIVES: We assessed possible myocardial involvement in previously cardiac healthy post-COVID patients referred for persisting symptoms with suspected myocarditis. BACKGROUND: Prior studies suggested myocardial inflammation in patients with coronavirus-induced disease 2019 (COVID-19). However, the prevalence of cardiac involvement among COVID patients varied between 1.4 and 78%. METHODS: A total of 56 post-COVID patients without previous heart diseases were included consecutively into this study. All patients had positive antibody titers against SARS-CoV-2. Patients were referred for persistent symptoms such as chest pain/discomfort, shortness of breath, or intolerance to activity. All patients underwent standardized cardiac assessment including electrocardiogram (ECG), cardiac biomarkers, echocardiography, and cardiac magnetic resonance (CMR). RESULTS: 56 Patients (46 ± 12 years, 54% females) presented 71 ± 66 days after their COVID-19 disease. In most patients, the course of COVID-19 was mild, with hospital treatment being necessary in five (9%). At presentation, patients most often reported persistent fatigue (75%), chest pain (71%), and shortness of breath (66%). Acute myocarditis was confirmed by T1/T2-weighed CMR and elevated NTpro-BNP levels in a single patient (2%). Left ventricular ejection fraction was 56% in this patient. Additional eight patients (14%) showed suspicious CMR findings, including myocardial edema without fibrosis (n = 3), or non-ischemic myocardial injury suggesting previous inflammation (n = 5). However, myocarditis could ultimately not be confirmed according to 2018 Lake Louise criteria; ECG, echo and lab findings were inconspicuous in all eight patients. CONCLUSIONS: Among 56 post-COVID patients with persistent thoracic complaints final diagnosis of myocarditis could be confirmed in a single patient using CMR.


Subject(s)
COVID-19/complications , Heart/virology , Magnetic Resonance Imaging/methods , Myocarditis/virology , Adult , COVID-19/diagnosis , Echocardiography , Electrocardiography , Female , Heart/diagnostic imaging , Humans , Male , Middle Aged , Myocarditis/diagnostic imaging , Stroke Volume , Ventricular Function, Left
11.
J Korean Med Sci ; 36(32): e229, 2021 Aug 16.
Article in English | MEDLINE | ID: covidwho-1360704

ABSTRACT

Increasing rates of coronavirus disease 2019 (COVID-19) vaccination coverage will result in more vaccine-related side effects, including acute myocarditis. In Korea, we present a 24-year-old male with acute myocarditis following COVID-19 vaccination (BNT162b2). His chest pain developed the day after vaccination and cardiac biomarkers were elevated. Echocardiography showed minimal pericardial effusion but normal myocardial contractility. Electrocardiography revealed diffuse ST elevation in lead II, and V2-5. Cardiac magnetic resonance images showed the high signal intensity of T2- short tau inversion recovery image, the high value of T2 mapping sequence, and late gadolinium enhancement in basal inferior and inferolateral wall. It was presumed that COVID-19 mRNA vaccination was probably responsible for acute myocarditis. Clinical course of the patient was favorable and he was discharged without any adverse event.


Subject(s)
COVID-19 Vaccines/adverse effects , Heart/diagnostic imaging , Myocarditis/diagnostic imaging , Myocarditis/pathology , Myocardium/pathology , COVID-19/immunology , COVID-19/prevention & control , Chest Pain/pathology , Echocardiography , Electrocardiography , Humans , Magnetic Resonance Imaging , Male , Republic of Korea , Vaccination/adverse effects , Young Adult
12.
Pediatrics ; 148(3)2021 09.
Article in English | MEDLINE | ID: covidwho-1359109

ABSTRACT

Trials of coronavirus disease 2019 (COVID-19) vaccination included limited numbers of children, so they may not have detected rare but important adverse events in this population. We report 7 cases of acute myocarditis or myopericarditis in healthy male adolescents who presented with chest pain all within 4 days after the second dose of Pfizer-BioNTech COVID-19 vaccination. Five patients had fever around the time of presentation. Acute COVID-19 was ruled out in all 7 cases on the basis of negative severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction test results of specimens obtained by using nasopharyngeal swabs. None of the patients met criteria for multisystem inflammatory syndrome in children. Six of the 7 patients had negative severe acute respiratory syndrome coronavirus 2 nucleocapsid antibody assay results, suggesting no previous infection. All patients had an elevated troponin. Cardiac MRI revealed late gadolinium enhancement characteristic of myocarditis. All 7 patients resolved their symptoms rapidly. Three patients were treated with nonsteroidal antiinflammatory drugs only, and 4 received intravenous immunoglobulin and corticosteroids. In this report, we provide a summary of each adolescent's clinical course and evaluation. No causal relationship between vaccine administration and myocarditis has been established. Continued monitoring and reporting to the US Food and Drug Administration Vaccine Adverse Event Reporting System is strongly recommended.


Subject(s)
COVID-19 Vaccines/adverse effects , Myocarditis/etiology , Acute Disease , Adolescent , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Nucleic Acid Testing , COVID-19 Vaccines/administration & dosage , Coronavirus Nucleocapsid Proteins/immunology , Gadolinium , Humans , Magnetic Resonance Imaging , Male , Myocarditis/diagnostic imaging , Phosphoproteins/immunology , Systemic Inflammatory Response Syndrome/diagnosis , Time Factors , Troponin/blood , Young Adult
13.
Hamostaseologie ; 41(5): 366-370, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1356592

ABSTRACT

Diagnosing myocarditis is still challenging due to its varying presentation ranging from none or mild symptoms to sudden cardiac death. Clinical presentation, electrocardiography, and cardiac biomarkers seem not to be sufficient for a reliable diagnosis. In fact, an unequivocal myocardial characterization is needed, applying endomyocardial biopsy (EMB) and cardiac magnetic resonance (CMR), a technique which demonstrates high accuracy to histology. Besides the assessment of functional parameters (volumes, ejection fraction), established late gadolinium enhancement and recent T1 and T2 mapping techniques including the calculation of extracellular volume fraction allow distinct myocardial tissue analysis by a noninvasive approach without the need of radiation. However, EMB is the only method which allows the identification of the underlying etiology of cardiac inflammation. Since myocardial damage and inflammation seem to be prevalent in a considerable number of patients even in the mid-term range after COVID-19, CMR and EMB seem to be adequate tools to further investigate these findings. In this article, we will (1) review current knowledge about the role of CMR in the COVID-19 pandemic and (2) report about our own EMB findings in COVID-19 patients in the Cardiopathology Center of our University Hospital.


Subject(s)
COVID-19/complications , Myocarditis/diagnosis , Myocarditis/etiology , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy/methods , Endocardium/pathology , Female , Heart Disease Risk Factors , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Myocarditis/diagnostic imaging , Myocardium/pathology , Pandemics , SARS-CoV-2/pathogenicity , Young Adult
14.
BMC Cardiovasc Disord ; 21(1): 375, 2021 08 04.
Article in English | MEDLINE | ID: covidwho-1339117

ABSTRACT

BACKGROUND: Half of U.S. adults have received at least one dose of the COVID-19 vaccines produced by either Pfizer, Moderna, or Johnson and Johnson, which represents a major milestone in the ongoing pandemic. Given the emergency use authorizations for these vaccines, their side effects and safety were assessed over a compressed time period. Hence, ongoing monitoring for vaccine-related adverse events is imperative for a full understanding and delineation of their safety profile. CASE PRESENTATION: An 22-year-old Caucasian male presented to our hospital center complaining of pleuritic chest pain. Six months prior he had a mild case of COVID-19, but was otherwise healthy. He had received his first dose of the Moderna vaccine three days prior to developing symptoms. Laboratory analysis revealed a markedly elevated troponin and multiple imaging modalities during his hospitalization found evidence of wall motion abnormalities consistent with a diagnosis of perimyocarditis. He was started on aspirin and colchicine with marked improvement of his symptoms prior to discharge. CONCLUSIONS: We present a case of perimyocarditis that was temporally related to COVID-19 mRNA vaccination in an young male with prior COVID-19 infection but otherwise healthy. Our case report highlights an albeit rare but important adverse event for clinicians to be aware of. It also suggests a possible mechanism for the development of myocardial injury in our patient.


Subject(s)
COVID-19 Vaccines/adverse effects , Myocarditis/chemically induced , Anti-Inflammatory Agents/therapeutic use , Aspirin/therapeutic use , COVID-19 Vaccines/administration & dosage , Colchicine/therapeutic use , Humans , Immunization Schedule , Male , Myocarditis/diagnostic imaging , Myocarditis/drug therapy , Myocarditis/physiopathology , Recovery of Function , Treatment Outcome , Young Adult
18.
Echocardiography ; 38(8): 1327-1335, 2021 08.
Article in English | MEDLINE | ID: covidwho-1316882

ABSTRACT

BACKGROUND: Coronavirus 2019 (COVID-19) causes morbidity and mortality in an increasing number of people worldwide. Although it mainly affects the respiratory system, it influences all organs, including the heart. It is associated with a broad spectrum of widespread cardiovascular problems ranging from mild myocardial injury to fulminant myocarditis. We aimed to evaluate the presence and prevalence of cardiac involvement in asymptomatic or symptomatic patients after they recovered from COVID 19 infection. METHODS: A total of 100 consecutive patients with COVID-19 proven by reverse transcription polymerase chain reaction (RT-PCR), under 40 years of age and without any known additional chronic diseases were analyzed retrospectively for cardiac magnetic resonance (CMR) results and symptoms. RESULTS: Cardiac involvement was detected in 49 out of 100 patients on CMR imaging. In the cardiac involvement group, the number of patients with chest pain and/or dyspnea was 41 (84%), which was statistically significant (p = 0.001). Twenty-four patients (47%) in the without cardiac involvement group were asymptomatic and this was also statistically significant (p = 0.001). LV ejection fraction was statistically significantly lower in the group with cardiac involvement (61% vs 66%, p = 0.001). LV stroke volume and tricuspid annular plane systolic excursion (TAPSE) were statistically significantly lower in patients with cardiac involvement (p = 0.028 and p = 0.019, respectively). CONCLUSION: Based on single center experience, myocardial involvement is common in symptomatic patients after COVID-19. More studies are needed for long-term side effects and clinical results in these patients.


Subject(s)
COVID-19 , Myocarditis , Humans , Magnetic Resonance Imaging , Myocarditis/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Stroke Volume
20.
Clin Imaging ; 78: 247-249, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1281398

ABSTRACT

We report two cases of myocarditis, in two young and previously healthy individuals, temporally related to the second dose of the mRNA-COVID-19 vaccine. Both patients developed acute chest pain, changes on electrocardiogram (ECG), and elevated serum troponin within two days of receiving their second dose. Cardiac magnetic resonance (CMR) findings were consistent with acute myocarditis.


Subject(s)
COVID-19 , Myocarditis , COVID-19 Vaccines , Humans , Myocarditis/diagnostic imaging , RNA, Messenger , SARS-CoV-2
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