2021-09-21

Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States of America. Electronic address: Antonio.abbate@vcuhealth.org.; Allergy, Immunology and Rheumatology, Virginia Commonwealth University, Richmond, VA, United States of America.; Allergy, Immunology and Rheumatology, Virginia Commonwealth University, Richmond, VA, United States of America.; Anesthesiology, Virginia Commonwealth University, Richmond, VA, United States of America.; Anesthesiology, Virginia Commonwealth University, Richmond, VA, United States of America.; Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, United States of America.; Infectious Disease - Virginia Commonwealth University, Richmond, VA, United States of America.; Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States of America.; Allergy, Immunology and Rheumatology, Virginia Commonwealth University, Richmond, VA, United States of America.; Allergy, Immunology and Rheumatology, Virginia Commonwealth University, Richmond, VA, United States of America. Electronic address: Stamatina.danielides@vcuhealth.org.

Immune-mediated myocardial injury following Severe Acute Respiratory Syndrome Coronavirys-2 (SARS-CoV2) infection has been described in adults and children. Cases of myocarditis following immunization for SARS-CoV2 have recently been documented, mostly associated with mild severity and spontaneous recovery. We herein report two cases of fulminant myocarditis following BNT162b2 mRNA Covid-19 vaccination associated with systemic hyperinflammatory syndrome and refractory shock requiring support with veno-arterial extracorporeal membrane oxygenation.CI - Copyright © 2021 Elsevier B.V. All rights reserved.

2021-08-24

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.; Department of Cardiology, School of Medicine & Institute of Medical Science, Keimyung University, Daegu, Korea.; Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea. khyungseop@dsmc.or.kr.; Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.; Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.; Department of Radiology, Keimyung University Dongsan Medical Center, Daegu, Korea.

Increasing rates of coronavirus disease 2019 (COVID-19) vaccination coverage will result in more vaccine-related side effects, including acute myocarditis. In Korea, we present a 24-year-old male with acute myocarditis following COVID-19 vaccination (BNT162b2). His chest pain developed the day after vaccination and cardiac biomarkers were elevated. Echocardiography showed minimal pericardial effusion but normal myocardial contractility. Electrocardiography revealed diffuse ST elevation in lead II, and V2-5. Cardiac magnetic resonance images showed the high signal intensity of T2- short tau inversion recovery image, the high value of T2 mapping sequence, and late gadolinium enhancement in basal inferior and inferolateral wall. It was presumed that COVID-19 mRNA vaccination was probably responsible for acute myocarditis. Clinical course of the patient was favorable and he was discharged without any adverse event.CI - © 2021 The Korean Academy of Medical Sciences.

2021-08-24

Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.; Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.; Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.; Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.; Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.; Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. yaejeankim@skku.edu.

BACKGROUND: Korean health authority plans to vaccinate adolescents against coronavirus disease 2019 (COVID-19) starting high school seniors during the summer vacation of 2021. However, the myocarditis/pericarditis following COVID-19 vaccine has been reported recently in adolescents and young adults. This study was performed to answer the urgent questions about the basic epidemiology and clinical course of myocarditis/pericarditis in hospitalized patients prior to the introduction of COVID-19 vaccines in pediatric population. METHODS: A retrospective medical record analysis including frequency, clinical characteristics, etiology and outcome of myocarditis/pericarditis was conducted in 17 years and younger patients who were hospitalized in two referral hospitals in Korea between 2010 and 2019. RESULTS: Total 142 patients with myocarditis (n = 119) and/or pericarditis (n = 23) were identified. Median age was 5.4 years (interquartile range, 0.6-12.9 years; range, 11 days-17.8 years), and

2021-08-08

Cardiology Center, University of Ferrara, Viale Aldo Moro 8, 44024, Cona, Ferrara, Italy. donatomele@libero.it.; Cardiology Center, University of Ferrara, Viale Aldo Moro 8, 44024, Cona, Ferrara, Italy.; Cardiology Center, University of Ferrara, Viale Aldo Moro 8, 44024, Cona, Ferrara, Italy.; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy.; Cardiology Center, University of Ferrara, Viale Aldo Moro 8, 44024, Cona, Ferrara, Italy.; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy.

Myocarditis has been reported as a possible clinical presentation or complication in patients with coronavirus disease (COVID)-19 due to SARS-CoV-2. Despite the alarm that this possibility generated among physicians, there is paucity of information about mechanisms, prevalence, prognosis, diagnosis and therapy of myocarditis in the context of COVID-19. This brief review has the goal to revise and summarize current knowledge on myocarditis in COVID-19 patients and underline problems especially related to diagnosis and treatment.CI - © 2021. Società Italiana di Medicina Interna (SIMI).

Department of Medicine I, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, Jena, 07747, Germany.; MVZ für Klinische Pathologie, Klinikum Darmstadt GmbH, Darmstadt, Germany.; Department of Medicine I, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, Jena, 07747, Germany.; Department of Medicine I, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, Jena, 07747, Germany.; Department of Medicine I, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, Jena, 07747, Germany.; Department of Medicine I, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, Jena, 07747, Germany.

We describe a case of a 20-year-old healthy man developing chest pain and classical symptoms of vaccine reactogenicity 12 h after receiving the first dose of mRNA-1273 (Moderna). Cardiac troponin T was increased, and subepicardial inflammation and focal contractile dysfunction were detected by cardiac magnetic resonance imaging and echocardiography. We confirmed the diagnosis of acute myocarditis by endomyocardial biopsy demonstrating significant infiltration of monocytes and T lymphocytes. Although we detected IgG against nucleocapsid protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) indicating prior infection, the patient repeatedly tested negative for SARS-CoV-2 and had been asymptomatic for several months. Furthermore, viral genome analysis of endomyocardial biopsy samples was negative for SARS-CoV-2 and other potential cardiotropic viruses. These findings and the strong temporal relation between the vaccination and the symptom onset imply a potential side

2021-08-05

Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.; Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.; Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.; Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. cremerp@ccf.org.

PURPOSE OF REVIEW: In coronavirus disease 2019 (COVID-19), myocardial injury occurs frequently in severe or critically ill hospitalized patients, yet myocarditis is much less common. In this context, revisiting the definition of myocarditis is appropriate with a specific focus on diagnostic and management considerations in patients infected with SARS-CoV-2. RECENT FINDINGS: Pathologic cardiac specimens from patients with COVID-19 suggest a mixed inflammatory response involving lymphocytes and macrophages, and importantly, cellular injury occurs predominantly at the level of pericytes and endothelial cells, less often involving direct myocyte necrosis. In COVID-19, the diagnosis of myocarditis has understandably been based predominantly on clinical criteria, and the number of patients with clinically suspected myocarditis who would meet diagnostic histological criteria is unclear. Echocardiography and cardiac magnetic resonance are important diagnostic tools, although the prognostic

2021-06-20

Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.; CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.; Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.; CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.; Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.; Department of Pharmacology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.; Department of Pharmacology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.; CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.; Department of Cardiology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.; CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.; Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.; Department of Pharmacology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.; Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.; CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.CN - French COVID cohort study group

AIMS: Myocardial injury is frequently observed in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. Different cardiac abnormalities have been reported during the acute COVID-19 phase, ranging from infra-clinic elevations of myocardial necrosis biomarkers to acute cardiac dysfunction and myocarditis. There is limited information on late cardiac sequelae in patients who have recovered from acute COVID-19 illness. We aimed to document the presence and quantify the extent of myocardial functional alterations in patients hospitalized 6 months earlier for COVID-19 infection. METHODS AND RESULTS: We conducted a prospective echocardiographic evaluation of 48 patients (mean age 58 ± 13 years, 69% male) hospitalized 6 ± 1 month earlier for a laboratory-confirmed and symptomatic COVID-19. Thirty-two (66.6%) had pre-existing cardiovascular risks factors (systemic hypertension, diabetes, or dyslipidaemia), and three patients (6.2%) had a known prior myocardial infarction.

2021-03-04

Pediatric Cardiology and Cardiac Surgery Unit, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Department of Pediatrics, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Department of Anesthesiology, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Department of Radiology, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Department of Pediatrics, Maggiore Hospital, Bologna, Italy.; Pediatric Cardiology and Cardiac Surgery Unit, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Pediatric Cardiology and Cardiac Surgery Unit, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Department of Pediatrics, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Department of Pediatrics, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Pediatric Cardiology and Cardiac Surgery Unit, University of Bologna, S. Orsola Hospital, Bologna, Italy.; Department of Pediatrics, University of Bologna, S. Orsola Hospital, Bologna, Italy.

A 6-year-old African boy with multi-viral infection including parvovirus B19 and severe acute respiratory syndrome coronavirus 2 was admitted for persistent fever associated with respiratory distress and myocarditis complicated by cardiogenic shock needing ventilatory and inotropic support. Coronary aneurysms were also documented in the acute phase. Blood tests were suggestive of macrophage activation syndrome. He was treated with intravenous immunoglobulins, aspirin, diuretics, dexamethasone, hydroxychloroquine, and prophylactic low molecular weight heparin. Normalization of cardiac performance and coronary diameters was noticed within the first days. Cardiac magnetic resonance imaging, performed 20 days after the hospitalization, evidenced mild myocardial interstitial oedema with no focal necrosis, suggesting a mechanism of cardiac stunning related to cytokines storm rather than direct viral injury of cardiomyocytes.CI - © 2020 The Authors. ESC Heart Failure published by John Wiley

2021-03-04

Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.; Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany.; Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany.; Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert Schweitzer Campus 1, A1, Münster, 48149, Germany.; Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert Schweitzer Campus 1, A1, Münster, 48149, Germany.; Department of Anesthesiology, Perioperative Care, and Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.; Department of Anesthesiology, Perioperative Care, and Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.; Department of Anesthesiology, Perioperative Care, and Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.; Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.; Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany.; Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany.; Department of Pulmonology, Kepler University Hospital, Linz, Austria.; Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital Linz, Johannes-Kepler-University, Linz, Austria.; Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.; 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria.; Department of Pulmonology, Kepler University Hospital, Linz, Austria.; Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert Schweitzer Campus 1, A1, Münster, 48149, Germany.; Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.; Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert Schweitzer Campus 1, A1, Münster, 48149, Germany.; Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.

AIMS: COVID-19, a respiratory viral disease causing severe pneumonia, also affects the heart and other organs. Whether its cardiac involvement is a specific feature consisting of myocarditis, or simply due to microvascular injury and systemic inflammation, is yet unclear and presently debated. Because myocardial injury is also common in other kinds of pneumonias, we investigated and compared such occurrence in severe pneumonias due to COVID-19 and other causes. METHODS AND RESULTS: We analysed data from 156 critically ill patients requiring mechanical ventilation in four European tertiary hospitals, including all n = 76 COVID-19 patients with severe disease course requiring at least ventilatory support, matched to n = 76 from a retrospective consecutive patient cohort of severe pneumonias of other origin (matched for age, gender, and type of ventilator therapy). When compared to the non-COVID-19, mortality (COVID-19 = 38.2% vs. non-COVID-19 = 51.3%, P = 0.142) and impairment of

2021-02-22

Department of Biopathology, CHRU Nancy, CHRU/ICL - bâtiment BBB, Rue du Morvan, 54511, Vandoeuvre-lès-Nancy, France. g.gauchotte@chru-nancy.fr.; Department of Legal Medicine, CHRU Nancy, Vandoeuvre-lès-Nancy, France. g.gauchotte@chru-nancy.fr.; INSERM U1256, NGERE, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France. g.gauchotte@chru-nancy.fr.; Centre de Ressources Biologiques, BB-0033-00035, CHRU, Nancy, France. g.gauchotte@chru-nancy.fr.; Department of Virology, CHRU Nancy, Vandoeuvre-lès-Nancy, France.; Department of Legal Medicine, CHRU Nancy, Vandoeuvre-lès-Nancy, France.; Department of Intensive Care Medicine, CHR Metz-Thionville, Ars-Laquenexy, France.; Department of Legal Medicine, CHRU Nancy, Vandoeuvre-lès-Nancy, France.; Department of Intensive Care Medicine, CHR Metz-Thionville, Ars-Laquenexy, France.; Department of Intensive Care Medicine, CHR Metz-Thionville, Ars-Laquenexy, France.

The coronavirus disease 2019 (COVID-19), due to SARS-CoV-2, is primarily a respiratory disease, causing in most severe cases life-threatening acute respiratory distress syndrome (ARDS). Cardiovascular involvement can also occur, such as thrombosis or myocarditis, generally associated with pulmonary lesions. Little is known about SARS-CoV-2-induced myocarditis. We report the case of a 69-year-old man suffering from a refractory cardiogenic shock, without significant lung involvement. Prior to death, several nasopharyngeal swabs and distal bronchoalveolar lavage were sampled in order to perform RT-PCR analyses for SARS-CoV-2-RNA, which all gave negative results. Autopsy showed coronary atherosclerosis, without acute complication. Microscopic examination of the heart revealed the existence of an intense multifocal inflammatory infiltration, in both ventricles and septum, composed in its majority of macrophages and CD8+ cytotoxic T lymphocytes (CD4/CD8 ratio: 0.11). Immunohistochemistry