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Myocardial Inflammation and Dysfunction in COVID-19-Associated Myocardial Injury.
Weckbach, Ludwig T; Curta, Adrian; Bieber, Stephanie; Kraechan, Angelina; Brado, Johannes; Hellmuth, Johannes C; Muenchhoff, Maximilian; Scherer, Clemens; Schroeder, Ines; Irlbeck, Michael; Maurus, Stefan; Ricke, Jens; Klingel, Karin; Kääb, Stefan; Orban, Mathias; Massberg, Steffen; Hausleiter, Jörg; Grabmaier, Ulrich.
  • Weckbach LT; Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.
  • Curta A; Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University, Planegg-Martinsried, Germany (L.T.W.).
  • Bieber S; German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.).
  • Kraechan A; COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.).
  • Brado J; Department of Radiology (A.C., S. Maurus, J.R.), Ludwig-Maximilians-University, Munich, Germany.
  • Hellmuth JC; Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.
  • Muenchhoff M; COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.).
  • Scherer C; Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.
  • Schroeder I; COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.).
  • Irlbeck M; Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.
  • Maurus S; Medical Department III (J.C.H.), Ludwig-Maximilians-University, Munich, Germany.
  • Ricke J; COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.).
  • Klingel K; COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.).
  • Kääb S; Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Faculty of Medicine, LMU München, Munich, Germany (M.M.).
  • Orban M; Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.
  • Massberg S; German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.).
  • Hausleiter J; COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.).
  • Grabmaier U; Department of Anaesthesiology (I.S., M.I.), Ludwig-Maximilians-University, Munich, Germany.
Circ Cardiovasc Imaging ; 14(1): e012220, 2021 01.
Article in English | MEDLINE | ID: covidwho-1035201
ABSTRACT

BACKGROUND:

Myocardial injury, defined by elevated troponin levels, is associated with adverse outcome in patients with coronavirus disease 2019 (COVID-19). The frequency of cardiac injury remains highly uncertain and confounded in current publications; myocarditis is one of several mechanisms that have been proposed.

METHODS:

We prospectively assessed patients with myocardial injury hospitalized for COVID-19 using transthoracic echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy.

RESULTS:

Eighteen patients with COVID-19 and myocardial injury were included in this study. Echocardiography revealed normal to mildly reduced left ventricular ejection fraction of 52.5% (46.5%-60.5%) but moderately to severely reduced left ventricular global longitudinal strain of -11.2% (-7.6% to -15.1%). Cardiac magnetic resonance showed any myocardial tissue injury defined by elevated T1, extracellular volume, or late gadolinium enhancement with a nonischemic pattern in 16 patients (83.3%). Seven patients (38.9%) demonstrated myocardial edema in addition to tissue injury fulfilling the Lake-Louise criteria for myocarditis. Combining cardiac magnetic resonance with speckle tracking echocardiography demonstrated functional or morphological cardiac changes in 100% of investigated patients. Endomyocardial biopsy was conducted in 5 patients and revealed enhanced macrophage numbers in all 5 patients in addition to lymphocytic myocarditis in 1 patient. SARS-CoV-2 RNA was not detected in any biopsy by quantitative real-time polymerase chain reaction. Finally, follow-up measurements of left ventricular global longitudinal strain revealed significant improvement after a median of 52.0 days (-11.2% [-9.2% to -14.7%] versus -15.6% [-12.5% to -19.6%] at follow-up; P=0.041).

CONCLUSIONS:

In this small cohort of COVID-19 patients with elevated troponin levels, myocardial injury was evidenced by reduced echocardiographic left ventricular strain, myocarditis patterns on cardiac magnetic resonance, and enhanced macrophage numbers but not predominantly lymphocytic myocarditis in endomyocardial biopsies.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Myocarditis / Myocardium Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Circ Cardiovasc Imaging Journal subject: Vascular Diseases / Cardiology / Diagnostic Imaging Year: 2021 Document Type: Article Affiliation country: CIRCIMAGING.120.011713

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Myocarditis / Myocardium Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Circ Cardiovasc Imaging Journal subject: Vascular Diseases / Cardiology / Diagnostic Imaging Year: 2021 Document Type: Article Affiliation country: CIRCIMAGING.120.011713