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REVIEW ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 239-243

Acute Myocarditis Associated with Coronavirus Disease 2019: Systematic Review and Pooled Analysis of Reported Cases


1 Department of Heart Failure, Pulmonary Hypertension and Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
2 Clinical Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

Correspondence Address:
Dr. Lucrecia Maria Burgos
Instituto Cardiovascular de Buenos Aires, Blanco Encalada 1543, CABA. CP1428, Aires, Buenos Aires
Argentina
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_88_20

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Context: Coronavirus disease (COVID-19) clinical manifestations are mainly respiratory, although cardiac complications are being reported. However, specific information about the clinical characteristics and in-hospital outcomes of patients with myocarditis associated with COVID-2019 is limited. Aim: The aim is to describe the clinical characteristics and outcomes of patients with acute myocarditis associated with COVID-19. Methods: The study consisted of a systematic review of all available case reports. Systematic searches were conducted using MEDLINE (PubMed interface) LILACS and Scielo to identify studies from December 2019 to 11 July 2020 involving adult patients with acute myocarditis associated with COVID-19. Results: Twenty patients were included. The median age was 49 years (interquartile range [IQR] 32.25–69), and 60% were male. Ten patients presented ST-segment elevation on the ECG. All patients had elevated serum levels of troponin T or I, N-terminal pro-brain natriuretic peptide (median 3436 ng/L, IQR 1315-12054) and C-reactive protein (median 33 mg/L, IQR 18–94). Interleukin-6 was measured in three patients, presenting elevated values as well. Left ventricular ejection fraction (LVEF) was severely impaired in 60% of the patients. Half of the patients received corticosteroids, 43.7% antivirals and 31.3% hydroxychloroquine. Moreover, 15.8% of patients underwent mechanical circulatory support. Most patients (90.9%) recovered heart function with LVEF above 40%. In-hospital mortality rate was 15.8%, the main cause of death being bacterial septic shock (75%). Conclusion: Several cases of coronavirus-related myocarditis have been reported. The clinical presentation was heterogeneous. The vast majority of patients were treated with steroids and antivirals. Most patients recovered cardiac function; however, mortality was relatively high.


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