COVID-19 vs. Classical Myocarditis Associated Myocardial Injury Evaluated by Cardiac Magnetic Resonance and Endomyocardial Biopsy

Frontiers in Cardiovascular Medicine

Sophie Van Linthout¹  Carsten Tschöpe¹  Karin Klingel²  Alessandro Faragli³  Radu Tanacli³  Grigorios Korosoglou⁴  Collin Götze⁵  Alexander Berger⁵  Felix Pröpper⁵  Victoria Zieschang⁵  Patrick Doeblin⁵  Jennifer Erley⁵  Martin Witzenrath⁶  Fridolin Steinbeis⁶  Thula Cannon Walter-Rittel⁷  Dominik Geisel⁷  Jakob Weiss⁸  Philipp Stawowy⁸  Burkert Pieske⁸  Sebastian Kelle⁸  Franziska Seidel⁹  Titus Kühne⁹  Christian Stehning^1,10 

[1] 0Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany;Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany;Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany;Department of Cardiology, GRN Hospital Weinheim, Weinheim, Germany;Department of Cardiology, German Heart Centre Berlin, Berlin, Germany;Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany;Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany;German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany;Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany;Philips Healthcare Systems, Hamburg, Germany;

关键词: COVID-19;    myocarditis;    Lake Louise Criteria;    CMR;    biopsy;    inflammation;   

DOI  :  10.3389/fcvm.2021.737257

来源: DOAJ

【 摘 要 】

Background: Despite the ongoing global pandemic, the impact of COVID-19 on cardiac structure and function is still not completely understood. Myocarditis is a rare but potentially serious complication of other viral infections with variable recovery, and is, in some cases, associated with long-term cardiac remodeling and functional impairment.Aim: To assess myocardial injury in patients who recently recovered from an acute SARS-CoV-2 infection with advanced cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB).Methods: In total, 32 patients with persistent cardiac symptoms after a COVID-19 infection, 22 patients with acute classic myocarditis not related to COVID-19, and 16 healthy volunteers were included in this study and underwent a comprehensive baseline CMR scan. Of these, 10 patients post COVID-19 and 13 with non-COVID-19 myocarditis underwent a follow-up scan. In 10 of the post-COVID-19 and 15 of the non-COVID-19 patients with myocarditis endomyocardial biopsy (EMB) with histological, immunohistological, and molecular analysis was performed.Results: In total, 10 (31%) patients with COVID-19 showed evidence of myocardial injury, eight (25%) presented with myocardial oedema, eight (25%) exhibited global or regional systolic left ventricular (LV) dysfunction, and nine (28%) exhibited impaired right ventricular (RV) function. However, only three (9%) of COVID-19 patients fulfilled updated CMR–Lake Louise criteria (LLC) for acute myocarditis. Regarding EMB, none of the COVID-19 patients but 87% of the non-COVID-19 patients with myocarditis presented histological findings in keeping with acute or chronic inflammation. COVID-19 patients with severe disease on the WHO scale presented with reduced biventricular longitudinal function, increased RV mass, and longer native T1 times compared with those with only mild or moderate disease.Conclusions: In our cohort, CMR and EMB findings revealed that SARS-CoV-2 infection was associated with relatively mild but variable cardiac involvement. More symptomatic COVID-19 patients and those with higher clinical care demands were more likely to exhibit chronic inflammation and impaired cardiac function compared to patients with milder forms of the disease.

【 授权许可】

Unknown