Clinical and cardiac magnetic resonance findings in post-COVID patients referred for suspected myocarditis.
Clinical and cardiac magnetic resonance findings in post-COVID patients referred for suspected myocarditis.
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DOI：
10.1007/s00392-021-01929-5
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Eggebrecht H
中科院分区：
文献类型：
--
作者：
Breitbart P;Koch A;Schmidt M;Magedanz A;Lindhoff-Last E;Voigtländer T;Schmermund A;Mehta RH;Eggebrecht H
我们评估了先前心脏健康的冠状病毒感染后因疑似心肌炎持续症状而转诊的患者可能的心肌损害。先前的研究表明，冠状病毒引起的疾病患者中存在心肌炎(新冠肺炎)。然而，COVID患者中心脏受累的患病率从1.4%到78%不等。共56例无心脏病史的冠状病毒感染后患者被连续纳入本研究。所有患者的SARS-CoV-2抗体效价均为阳性。患者被转诊为持续性症状，如胸痛/不适、呼吸短促或活动不耐受。所有患者都接受了标准化的心脏评估，包括心电图、心脏生物标志物、超声心动图和心脏磁共振(CMR)。56例患者(46 ± 12年，女性54%)在发病后66天出现71 ± 。在大多数患者中，新冠肺炎的病程较轻，5例(9%)需要住院治疗。在表现时，患者最常报告的是持续性疲劳(75%)、胸痛(71%)和呼吸短促(66%)。1例患者(2%)T1/T2加权CMR和NTproBNP水平升高证实为急性心肌炎。这位患者的左心室射血分数为56%。另有8名患者(14%)表现可疑，包括无纤维化的心肌水肿(n = 3)，或提示有炎症史的非缺血性心肌损伤(n = 5)。然而，根据2018年路易斯湖标准，心肌炎最终无法得到确认；所有8名患者的心电图、超声和实验室检查结果都不明显。在56例COVID后持续胸腔主诉的患者中，使用CMR可以在单个患者中确认心肌炎的最终诊断。
We assessed possible myocardial involvement in previously cardiac healthy post-COVID patients referred for persisting symptoms with suspected myocarditis. Prior studies suggested myocardial inflammation in patients with coronavirus-induced disease 2019 (COVID-19). However, the prevalence of cardiac involvement among COVID patients varied between 1.4 and 78%. A total of 56 post-COVID patients without previous heart diseases were included consecutively into this study. All patients had positive antibody titers against SARS-CoV-2. Patients were referred for persistent symptoms such as chest pain/discomfort, shortness of breath, or intolerance to activity. All patients underwent standardized cardiac assessment including electrocardiogram (ECG), cardiac biomarkers, echocardiography, and cardiac magnetic resonance (CMR). 56 Patients (46 ± 12 years, 54% females) presented 71 ± 66 days after their COVID-19 disease. In most patients, the course of COVID-19 was mild, with hospital treatment being necessary in five (9%). At presentation, patients most often reported persistent fatigue (75%), chest pain (71%), and shortness of breath (66%). Acute myocarditis was confirmed by T1/T2-weighed CMR and elevated NTpro-BNP levels in a single patient (2%). Left ventricular ejection fraction was 56% in this patient. Additional eight patients (14%) showed suspicious CMR findings, including myocardial edema without fibrosis (n = 3), or non-ischemic myocardial injury suggesting previous inflammation (n = 5). However, myocarditis could ultimately not be confirmed according to 2018 Lake Louise criteria; ECG, echo and lab findings were inconspicuous in all eight patients. Among 56 post-COVID patients with persistent thoracic complaints final diagnosis of myocarditis could be confirmed in a single patient using CMR.
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