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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
Semantic information from SemMedBD (by NLM)
1. Myocarditis COEXISTS_WITH myocardial injury
Subject
Myocarditis
Predicate
COEXISTS_WITH
Object
myocardial injury
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. myocardial injury PROCESS_OF Patients
Subject
myocardial injury
Predicate
PROCESS_OF
Object
Patients
4. Heart LOCATION_OF Magnetic Resonance Imaging
Subject
Heart
Predicate
LOCATION_OF
Object
Magnetic Resonance Imaging
5. Endomyocardium LOCATION_OF Biopsy
Subject
Endomyocardium
Predicate
LOCATION_OF
Object
Biopsy
6. Biopsy ADMINISTERED_TO Patients
Subject
Biopsy
Predicate
ADMINISTERED_TO
Object
Patients
7. Echocardiography ADMINISTERED_TO Patients
Subject
Echocardiography
Predicate
ADMINISTERED_TO
Object
Patients
8. Magnetic Resonance Imaging ADMINISTERED_TO Patients
Subject
Magnetic Resonance Imaging
Predicate
ADMINISTERED_TO
Object
Patients
9. Heart LOCATION_OF Morphologically altered structure
Subject
Heart
Predicate
LOCATION_OF
Object
Morphologically altered structure
10. Lymphocytic myocarditis PROCESS_OF Patients
Subject
Lymphocytic myocarditis
Predicate
PROCESS_OF
Object
Patients
11. Real-Time Polymerase Chain Reaction METHOD_OF Biopsy
Subject
Real-Time Polymerase Chain Reaction
Predicate
METHOD_OF
Object
Biopsy
12. Troponin ASSOCIATED_WITH COVID-19
Subject
Troponin
Predicate
ASSOCIATED_WITH
Object
COVID-19
13. myocardial injury DISRUPTS Heart Ventricle
Subject
myocardial injury
Predicate
DISRUPTS
Object
Heart Ventricle
14. Troponin PART_OF Patients
Subject
Troponin
Predicate
PART_OF
Object
Patients
15. Myocarditis COEXISTS_WITH myocardial injury
Subject
Myocarditis
Predicate
COEXISTS_WITH
Object
myocardial injury
16. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
17. myocardial injury PROCESS_OF Patients
Subject
myocardial injury
Predicate
PROCESS_OF
Object
Patients
18. Heart LOCATION_OF Magnetic Resonance Imaging
Subject
Heart
Predicate
LOCATION_OF
Object
Magnetic Resonance Imaging
19. Endomyocardium LOCATION_OF Biopsy
Subject
Endomyocardium
Predicate
LOCATION_OF
Object
Biopsy
20. Biopsy ADMINISTERED_TO Patients
Subject
Biopsy
Predicate
ADMINISTERED_TO
Object
Patients
21. Echocardiography ADMINISTERED_TO Patients
Subject
Echocardiography
Predicate
ADMINISTERED_TO
Object
Patients
22. Magnetic Resonance Imaging ADMINISTERED_TO Patients
Subject
Magnetic Resonance Imaging
Predicate
ADMINISTERED_TO
Object
Patients
23. Heart LOCATION_OF Morphologically altered structure
Subject
Heart
Predicate
LOCATION_OF
Object
Morphologically altered structure
24. Lymphocytic myocarditis PROCESS_OF Patients
Subject
Lymphocytic myocarditis
Predicate
PROCESS_OF
Object
Patients
25. Real-Time Polymerase Chain Reaction METHOD_OF Biopsy
Subject
Real-Time Polymerase Chain Reaction
Predicate
METHOD_OF
Object
Biopsy
26. Troponin ASSOCIATED_WITH COVID-19
Subject
Troponin
Predicate
ASSOCIATED_WITH
Object
COVID-19
27. myocardial injury DISRUPTS Heart Ventricle
Subject
myocardial injury
Predicate
DISRUPTS
Object
Heart Ventricle
28. Troponin PART_OF Patients
Subject
Troponin
Predicate
PART_OF
Object
Patients
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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: COVID-19 / Myocarditis / Myocardium Subject: COVID-19 / Myocarditis / Myocardium Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Language: English Journal: Circ Cardiovasc Imaging Clinical aspect: Etiology / Prognosis Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: COVID-19 / Myocarditis / Myocardium Subject: COVID-19 / Myocarditis / Myocardium Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Language: English Journal: Circ Cardiovasc Imaging Clinical aspect: Etiology / Prognosis Year: 2021
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