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Article ; Online: COVID-19 and Myocarditis: Findings from Cardiac Magnetic Resonance Imaging and Endomyocardial Biopsies.

Greulich, Simon / Klingel, Karin

2021 Volume 41, Issue 5, Page(s) 366–370

Abstract: ... characterization is needed, applying endomyocardial biopsy (EMB) and cardiac magnetic resonance (CMR), a technique ... about the role of CMR in the COVID-19 pandemic and (2) report about our own EMB findings in COVID-19 patients ... in a considerable number of patients even in the mid-term range after COVID-19, CMR and EMB seem to be adequate ...

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.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy/methods ; COVID-19/complications ; Endocardium/pathology ; Female ; Heart Disease Risk Factors ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Myocarditis/diagnosis ; Myocarditis/diagnostic imaging ; Myocarditis/etiology ; Myocardium/pathology ; Pandemics ; SARS-CoV-2/pathogenicity ; Young Adult
Language	English
Publishing date	2021-08-14
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	801512-0
ISSN	2567-5761 ; 0720-9355
ISSN (online)	2567-5761
ISSN	0720-9355
DOI	10.1055/a-1539-8664
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: COVID-19 and Myocarditis: Findings from Cardiac Magnetic Resonance Imaging and Endomyocardial Biopsies

Greulich, Simon / Klingel, Karin

Hämostaseologie

2021 Volume 41, Issue 05, Page(s) 366–370

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.
Keywords	COVID-19 ; myocarditis ; CMR ; histology/immunohistology ; virus infection
Language	English
Publishing date	2021-08-14
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	801512-0
ISSN	2567-5761 ; 0720-9355
ISSN (online)	2567-5761
ISSN	0720-9355
DOI	10.1055/a-1539-8664
Database	Thieme publisher's database

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ab Jg. 2022: Lesesaal (EG)

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Article: Myocarditis and COVID-19 related issues.

Ciabatti, Michele / Zocchi, Chiara / Olivotto, Iacopo / Bolognese, Leonardo / Pieroni, Maurizio

Global cardiology science & practice

2023 Volume 2023, Issue 4, Page(s) e202328

Abstract: ... also associated with increased risk of myocarditis. COVID-19 and mRNA vaccine-related myocarditis ... myocardial damage with elevation of cardiac biomarkers have been reported in COVID-19 patients ... although histological demonstration of acute myocarditis has been rarely documented. Indeed while cardiac magnetic ...

Abstract	The recent COVID-19 (Coronavirus Disease 2019) pandemic by SARS-CoV2 infection has caused millions of deaths and hospitalizations across the globe. In the early pandemic phases, the infection had been initially considered a primary pulmonary disease. However, increasing evidence has demonstrated a wide range of possible cardiac involvement. Most of systemic and cardiac damage is likely sustained by a complex interplay between inflammatory, immune-related and thrombotic mechanisms. Biventricular failure and myocardial damage with elevation of cardiac biomarkers have been reported in COVID-19 patients, although histological demonstration of acute myocarditis has been rarely documented. Indeed while cardiac magnetic resonance findings include different patterns of myocardial involvement in terms of late gadolinium enhancement, histological data from necropsy and endomyocardial biopsy showed peculiar inflammatory patterns, mostly composed by macrophages. On the other hand COVID-19 vaccines based on mRN technology have been also associated with increased risk of myocarditis. COVID-19 and mRNA vaccine-related myocarditis present different clinical and imaging presentations and recent data suggest the presence of distinctive immunological mechanisms involved.
Language	English
Publishing date	2023-09-30
Publishing country	Qatar
Document type	Journal Article ; Review
ZDB-ID	2738381-7
ISSN	2305-7823
ISSN	2305-7823
DOI	10.21542/gcsp.2023.28
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Article ; Online: 2 Jahre COVID-19-Pandemie – was haben wir gelernt?

Maisch, Bernhard / Dörr, Rolf

Herz

2022 Volume 47, Issue 2, Page(s) 177–193

Abstract: ... levels and suspicious cardiac magnetic resonance imaging (MRI) findings are much more frequent. The best ... After 2 years and 5 waves of the coronavirus disease 2019 (COVID-19) pandemic in Germany and ... the involvement of the heart with myocarditis and pericarditis as well as the kidneys have short-term and also ...

Title translation	2 years COVID-19 pandemic-What have we learned?
Abstract	After 2 years and 5 waves of the coronavirus disease 2019 (COVID-19) pandemic in Germany and experience with superspreader events worldwide, we know that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly mutating virus with changing clinical phenotypes. Besides infections of the respiratory tract, which in severe cases are accompanied by pneumonia requiring mechanical ventilation, the involvement of the heart with myocarditis and pericarditis as well as the kidneys have short-term and also long-term consequences. We have learnt to deal with myocarditis and pericarditis in acute infections and after vaccinations, which in rare cases can also lead to myocarditis and pericarditis. Myocarditis with myocytolysis in autopsy specimens or endomyocardial biopsy specimens is rare. In contrast, elevated troponin levels and suspicious cardiac magnetic resonance imaging (MRI) findings are much more frequent. The best preventive measure is a complete double basic vaccination and booster vaccination with an mRNA vaccine. For patients and medical personnel precise information is given with respect to personal protective equipment and behavior (distancing-hygiene-mask-airing rule).
MeSH term(s)	COVID-19 ; Humans ; Pandemics/prevention & control ; SARS-CoV-2 ; Vaccination ; Vaccines, Synthetic ; mRNA Vaccines
Chemical Substances	Vaccines, Synthetic ; mRNA Vaccines
Language	German
Publishing date	2022-03-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	8262-4
ISSN	1615-6692 ; 0340-9937 ; 0946-1299
ISSN (online)	1615-6692
ISSN	0340-9937 ; 0946-1299
DOI	10.1007/s00059-022-05097-8
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Cardiac Involvement in COVID-19 Patients

Domenico Maria Carretta / Aline Maria Silva / Donato D’Agostino / Skender Topi / Roberto Lovero / Ioannis Alexandros Charitos / Angelika Elzbieta Wegierska / Monica Montagnani / Luigi Santacroce

Infectious Disease Reports, Vol 13, Iss 48, Pp 494-

A Contemporary Review

2021 Volume 517

Abstract: ... Left ventricular dysfunction and hypokinesis were commonly exhibited symptoms. Cardiac Magnetic Resonance Imaging (CMRI ... studies on patients diagnosed with a COVID-19-induced acute myocarditis, and a total of 50 reports were ... of acute myocarditis in the context of COVID-19 disease. Conclusions : While diagnostic criteria and ...

Abstract	Background : The widely variable clinical manifestations of SARS-CoV2 disease (COVID-19) range from asymptomatic infections to multiple organ failure and death. Among the organs affected is the heart. This does not only affect people who already have previous cardiovascular problems, but also healthy people. This is a reason not to overlook any symptoms or to perform targeted examinations, even if apparently unrelated to the heart, for quick recognition and timely therapy. Aim of the study : This review recapitulates the current state of knowledge on the potential mechanisms and manifestation of myocarditis in patients with COVID-19 infection. Methods : A web-based search of published data was performed for all relevant studies on patients diagnosed with a COVID-19-induced acute myocarditis, and a total of 50 reports were included. The analysis of the studies evaluated highlights a male predominance, with the average age of patients being 55 years. The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. Finally, we wanted to use a general evaluation without distinguishing between various countries, taking into consideration only the peer or reviewer, regardless of the declared value of the journals that have been published. Results and critical findings: The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. In most patients, elevated levels of cardiac and inflammatory biomarkers were measured. Left ventricular dysfunction and hypokinesis were commonly exhibited symptoms. Cardiac Magnetic Resonance Imaging (CMRI) confirmed the diagnosis of myocarditis with features of cardiac edema and cardiac injury. Nine patients underwent histopathological examination. Treatment with corticosteroids and immunoglobulins was the most applied strategy following the administration of antivirals. Discussion : Despite the exponentially growing knowledge on the management of COVID-19 infection, current available data on SARS-CoV2-correlated myocarditis are still limited, and several difficulties may be encountered in the differential diagnosis of acute myocarditis in the context of COVID-19 disease. Conclusions : While diagnostic criteria and evaluation strategies for myocarditis are well described, no guidelines for the diagnosis and treatment of myocarditis in COVID-19 patients have yet been established. Therefore, further research is needed to advance the understanding of this disease process and define the most appropriate strategic approach in these patients.
Keywords	SARS-CoV-2 ; viral myocarditis ; cardiomyopathy ; endomyocardial biopsy ; cardiac magnetic resonance ; cardiovascular therapy ; Other systems of medicine ; RZ201-999
Subject code	610
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Presentations, Diagnosis, and Treatment of Post-COVID Viral Myocarditis in the Inpatient Setting: A Narrative Review.

Sayegh, Michael N / Goins, Allie E / Hall, Mary Ann Kirkconnell / Shin, Yoo Mee

Cureus

2023 Volume 15, Issue 5, Page(s) e39338

Abstract: ... magnetic resonance imaging with a confirmed diagnosis of COVID-19. However, if these are not available, other studies ... age 50. The gold standard of diagnosis for myocarditis is endomyocardial biopsy and cardiac ... Acute COVID-19 infection is associated with myocarditis and cardiomyopathies, but the prevalence and ...

Abstract	While coronavirus disease 2019 (COVID-19) infection rates have declined, and mortality outcomes have improved with vaccines, targeted antiviral therapies, and improved care practices over the course of the pandemic, post-acute sequelae of SARS CoV-2 infection (PASC, also referred to as "long COVID") has emerged as a significant concern, even among individuals who appear to have fully recovered from their initial infection. Acute COVID-19 infection is associated with myocarditis and cardiomyopathies, but the prevalence and presentation of post-infectious myocarditis are unclear. We provide a narrative review of post-COVID myocarditis, including symptoms and signs, physical exam findings, diagnosis, and treatment strategies. Post-COVID myocarditis has a wide range of presentations, from very mild symptoms to severe ones that can include sudden cardiac death. Several studies have noted what appears to be a bimodal distribution of affected patients, with individuals under age 16 (particularly males) most affected, followed by those over age 50. The gold standard of diagnosis for myocarditis is endomyocardial biopsy and cardiac magnetic resonance imaging with a confirmed diagnosis of COVID-19. However, if these are not available, other studies such as electrocardiogram, echocardiography, and inflammatory markers can guide clinicians to diagnose post-COVID myocarditis when appropriate. Treatment is largely supportive and may include oxygen therapy, intravenous hydration, diuretics, steroids, and antivirals. Post-COVID myocarditis is rare but important to recognize as more patients present with this condition in the inpatient setting.
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.39338
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Clinical outcome of established diagnostic and treatment modalities of COVID-19-associated myocarditis: a systematic review.

Sai Santhosha Mrudula, Alla / Agarwal, Pahel / Vempati, Roopeessh / Alla, Deekshitha / Balusu, Kavya / Tarannum, Suha / Patel, Krish / Devaragudi, Sanjana / Patel, Devkumar / Sultana, Qamar / Paudel, Kusum

Annals of medicine and surgery (2012)

2023 Volume 85, Issue 7, Page(s) 3583–3594

Abstract: ... Cardiac magnetic resonance imaging yielded myocardial oedema (63.63%), and late gadolinium enhancement (54 ... and definitive treatment options for COVID-19 myocarditis. This review focuses on myocarditis ... COVID19)" OR "(COVID-19 VIRUS INFECTION)" AND "(MYOCARDITIS)". The results were tabulated and analyzed ...

Abstract	Despite the significant research and development of COVID-19 diagnostic and therapeutic approaches, the virus still poses a concern, particularly to groups that are already vulnerable. Several individuals experienced cardiac problems like myocardial infarction, arrhythmia, heart failure, cardiomyopathy, myocarditis, and pericarditis after they had recovered from the infection. Early diagnosis and timely management of sequelae are part of the therapy. However, there are gaps in the knowledge of the diagnostic and definitive treatment options for COVID-19 myocarditis. This review focuses on myocarditis associated with COVID-19. Objective: This systemic review provides the most recent overview of myocarditis caused by COVID-19, including clinical manifestations, diagnostic techniques, available treatments, and outcomes. Methods: The PubMed, Google Scholar, and ScienceDirect servers were used to conduct a systematic search in compliance with the PRISMA guidelines. Boolean search terms included "(COVID-19)" OR "(COVID19)" OR "(COVID-19 VIRUS INFECTION)" AND "(MYOCARDITIS)". The results were tabulated and analyzed. Results: A total of 32 studies, including 26 case reports and 6 case series, were included in the final analysis, and 38 cases of COVID-19-associated myocarditis were analyzed. Middle-aged men constituted the most affected population (60.52%). Dyspnoea (63.15%), chest pain or discomfort (44.73%), and fever (42.10%) were the prevalent presentations. ST-segment abnormalities were reported in 48.38% of cases on electrocardiography testing. Leucocytic infiltration (60%) was the frequent finding obtained on endomyocardial biopsy. Cardiac magnetic resonance imaging yielded myocardial oedema (63.63%), and late gadolinium enhancement (54.54%) as the most common findings. Reduced ejection fraction (75%) was the frequent result obtained on echocardiography. Corticosteroids (76.31%) and immunomodulators (42.10%) were the well-established in-hospital medications. Veno-arterial extracorporeal membrane oxygenation (35%) was the most common intervention used to support the treatment. The frequent in-hospital complications were cardiogenic shock (30.76%), followed by pneumonia (23.07%). The mortality rate was 7.9%. Conclusion: Early detection and timely management of myocarditis are essential to reduce the risk of developing further complications. It is crucial to emphasize the need to evaluate COVID-19 as a possible cause of myocarditis in populations that are young and healthy to avoid fatal consequences.
Language	English
Publishing date	2023-06-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1097/MS9.0000000000000964
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Article ; Online: Utility of cardiac magnetic resonance imaging in diagnosing eosinophilic myocarditis in a patient recently recovered from COVID-19: a grand round case report.

Rao, Karan / Arustamyan, Michael / Walling, Abby / Christodoulidis, Georgios / Ashwath, Mahi / Hagedorn, Joshua / Priya, Sarv

European heart journal. Case reports

2023 Volume 7, Issue 3, Page(s) ytad090

Abstract: ... and discuss the role of CMRI and endomyocardial biopsy (EMB) to differentiate between COVID-19 ... with polyangiitis (EGPA) is a rare disease, for which cardiac magnetic resonance imaging (CMRI) is a useful non ... asthma, and who recently recovered from COVID-19, presented to the emergency room with pleuritic ...

Abstract	Background: Eosinophilic myocarditis (EM) secondary to eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease, for which cardiac magnetic resonance imaging (CMRI) is a useful non-invasive modality for diagnosis. We present a case of EM in a patient who recently recovered from COVID-19 and discuss the role of CMRI and endomyocardial biopsy (EMB) to differentiate between COVID-19-associated myocarditis and EM. Case summary: A 20-year-old Hispanic male with a history of sinusitis and asthma, and who recently recovered from COVID-19, presented to the emergency room with pleuritic chest pain, dyspnoea on exertion, and cough. His presentation labs were pertinent for leucocytosis, eosinophilia, elevated troponin, and elevated erythrocyte sedimentation rate and C-reactive protein. The electrocardiogram showed sinus tachycardia. Echocardiogram showed an ejection fraction of 40%. The patient was admitted, and on day 2 of admission, he underwent CMRI which showed findings of EM and mural thrombi. On hospital day 3, the patient underwent right heart catheterization and EMB which confirmed EM. The patient was treated with steroids and mepolizumab. He was discharged on hospital day 7 and continued outpatient heart failure treatment. Discussion: This is a unique case of EM and heart failure with reduced ejection fraction as a presentation of EGPA, in a patient who recently recovered from COVID-19. In this case, CMRI and EMB were critical to identify the cause of myocarditis and helped in the optimal management of this patient.
Language	English
Publishing date	2023-02-18
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytad090
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Article ; Online: The Management of Acute Onset Complete Heart Block and Atrial Flutter in a Patient with COVID-19.

Hussain, Murtaza / Awuah, Dominic / Deliwala, Smit / Alkotob, Mohammed Luay / Seedahmed, Elfateh / Bachuwa, Ghassan

European journal of case reports in internal medicine

2022 Volume 9, Issue 2, Page(s) 3026

Abstract: ... magnetic resonance imaging (cMRI) and endomyocardial biopsies are the gold standard investigations. Anticoagulation should be ... heart block and atrial flutter in the setting of COVID-19. SARS-CoV-2 virulence mechanisms can cause fibrosis ... Coronavirus disease (COVID-19) has infected millions of people worldwide. Its cardiac presentations ...

Abstract	Coronavirus disease (COVID-19) has infected millions of people worldwide. Its cardiac presentations include myocarditis, arrhythmias and structural heart changes even in young and healthy individuals. The long-term sequelae of these manifestations are unknown. We describe a unique combination of complete heart block and atrial flutter in the setting of COVID-19. SARS-CoV-2 virulence mechanisms can cause fibrosis in the myocardium resulting in loss of sinus node dominance. The paradoxical finding of atrial flutter and complete heart block is very rare. Prompt cardiac evaluation and electrophysiological testing are important. Cardiac magnetic resonance imaging (cMRI) and endomyocardial biopsies are the gold standard investigations. Anticoagulation should be administered until atrioventricular synchrony is achieved. Learning points: Simultaneous atrial flutter and third-degree atrioventricular block (AVB) caused by COVID-19 infection should be treated with a pacemaker according to heart block guidelines.During the COVID-19 pandemic, we recommend leadless pacemaker implantation for third-degree AVB as it has a lower risk of infection compared with traditional percutaneous procedures.Due to a lack of long-term data, patients with cardiac manifestations from COVID-19 require close follow-up with individualized surveillance schedules.
Language	English
Publishing date	2022-02-23
Publishing country	Italy
Document type	Journal Article
ISSN	2284-2594
ISSN (online)	2284-2594
DOI	10.12890/2022_003026
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Article ; Online: COVID-19 myocarditis and long-term heart failure sequelae.

Liu, Jing / Deswal, Anita / Khalid, Umair

Current opinion in cardiology

2020 Volume 36, Issue 2, Page(s) 234–240

Abstract: ... magnetic resonance imaging, and even endomyocardial biopsy may be needed for timely diagnosis. Several treatment strategies ... on COVID-19 myocarditis and its long-term heart failure sequelae.: Recent findings: Several suspected ... have been described, including both supportive and targeted therapies.: Summary: COVID-19 can cause ...

Abstract	Purpose of review: The clinical syndrome of coronavirus disease 2019 (COVID-19) has become a global pandemic leading to significant morbidity and mortality. Cardiac dysfunction is commonly seen in these patients, often presenting as clinical heart failure. Accordingly, we aim to provide a comprehensive review on COVID-19 myocarditis and its long-term heart failure sequelae. Recent findings: Several suspected cases of COVID-19 myocarditis have been reported. It is often not clear if the acute myocardial dysfunction is caused by myocarditis or secondary to generalized inflammatory state of cytokine release or microvascular thrombotic angiopathy. Ischemia may also need to be ruled out. Regardless, myocardial dysfunction in these patients is associated with poor overall prognosis. Laboratory testing, echocardiography, cardiac magnetic resonance imaging, and even endomyocardial biopsy may be needed for timely diagnosis. Several treatment strategies have been described, including both supportive and targeted therapies. Summary: COVID-19 can cause a spectrum of ventricular dysfunction ranging from mild disease to fulminant myocarditis with hemodynamic instability. Future research is needed to understand the true prevalence of COVID-19 myocarditis, as well as to better define various diagnostic protocols and treatment strategies.
MeSH term(s)	COVID-19 ; Heart Failure/diagnosis ; Heart Failure/etiology ; Humans ; Myocarditis/diagnosis ; Myocarditis/epidemiology ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2020-12-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645186-x
ISSN	1531-7080 ; 0268-4705
ISSN (online)	1531-7080
ISSN	0268-4705
DOI	10.1097/HCO.0000000000000832
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