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Published on: December 19, 2020
Fulminant and Non-fulminant Clinical COVID-19 Myocarditis in the New York City Area in 2020
Christopher Wong1, Amtul Mansoor1, Thomas McGinn2,3
1Department of Medicine, North Shore University Hospital & Long Island Jewish Medical Center, Manhasset, NY, US.
Insights
COVID-19 myocarditis can be severe, with higher D-dimer and ferritin in fulminant cases. This study defines clinical characteristics and severity markers for COVID-19 myocarditis, aiding diagnosis where advanced imaging is unavailable.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- COVID-19 myocarditis is an emerging complication requiring better clinical definition.
- Diagnostic challenges exist due to limitations in endomyocardial biopsy and cardiac MRI.
- Further research is needed to characterize COVID-19 myocarditis severity and clinical presentation.
Purpose of the Study:
- To describe the clinical course, echocardiographic, and laboratory findings in patients with clinically defined COVID-19 myocarditis.
- To differentiate between fulminant and non-fulminant cases of COVID-19 myocarditis.
- To identify accessible markers for assessing COVID-19 myocarditis severity.
Main Methods:
- A cross-sectional observational study of 19 patients with clinically defined COVID-19 myocarditis.
- Stratification of patients into non-fulminant and fulminant myocarditis groups.
- Comparison of laboratory findings using Student t-test and univariate logistic regression.
Main Results:
- No prior history of coronary artery disease, atrial fibrillation, or heart failure was noted.
- 21.1% of patients died, and 78.9% required supplemental oxygen.
- Significantly higher D-dimer and ferritin levels were observed in fulminant cases; 26.3% had pericardial effusions.
Conclusions:
- This study provides a practical clinical depiction of COVID-19 myocarditis, differentiating fulminant and non-fulminant presentations.
- Elevated inflammatory markers in fulminant cases suggest a role for systemic inflammation.
- Accessible laboratory findings can help define COVID-19 myocarditis severity, especially where advanced diagnostics are limited.
Background:
COVID-19 myocarditis is becoming increasingly appreciated as a complication of COVID-19. There are significant hurdles to formal diagnosis with endomyocardial biopsy or cardiac MRI, whether by resource limitations, patient instability, or isolation precautions. Therefore, further exploratory analysis is needed to clinically define the characteristics and spectrum of severity of COVID-19 myocarditis.
Objectives:
The aim of this study was to describe the clinical course, echocardiographic, and laboratory testing across suspected fulminant and non-fulminant clinically defined COVID-19 myocarditis.
Methods:
In a cross-sectional observational study of 19 patients with clinically defined COVID-19 myocarditis, we report presenting symptoms, clinical course, laboratory findings, and echocardiographic results stratified by non-fulminant and fulminant myocarditis. Student t-test and univariate logistic regression are used to compare laboratory findings across fulminant and non-fulminant cases.
Findings:
Among 19 patients, there was no prior history of coronary artery disease, atrial fibrillation, or heart failure; 21.1% of patients died; and 78.9% of cases required supplemental oxygen. A significantly higher geometric mean D-dimer and ferritin were observed in patients with fulminant compared to non-fulminant suspected myocarditis. 26.3% of cases had pericardial effusions. 10 out of the 16 with available echocardiographic data had normal left ventricular systolic function.
Conclusions:
In this study, we provide a practical clinical depiction of patients with clinical COVID-19 myocarditis across fulminant and non-fulminant cases. Statistically significant elevations in inflammatory markers in fulminant versus non-fulminant cases generate hypotheses regarding the role of systemic inflammation. While cardiac MRI and endomyocardial biopsy may not be accessible at scale in low- and middle-income countries, the present study offers a clinical definition of COVID-19 myocarditis and accessible laboratory findings to define severity.
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