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Myocarditis and COVID-19 related issues
Michele Ciabatti1, Chiara Zocchi1, Iacopo Olivotto2,3
1Cardiovascular Department, San Donato Hospital, Arezzo, Italy.
Insights
The COVID-19 virus can cause heart damage through inflammation and clotting, leading to conditions like biventricular failure. mRNA vaccines also carry a risk of myocarditis, with distinct clinical and immunological profiles compared to COVID-19 infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- The COVID-19 pandemic, caused by SARS-CoV-2, initially viewed as a pulmonary disease, has shown significant cardiac involvement.
- Cardiac damage in COVID-19 patients involves inflammatory, immune-related, and thrombotic mechanisms, leading to biventricular failure and myocardial injury.
Purpose of the Study:
- To explore the cardiac manifestations of COVID-19 infection and mRNA vaccine-related myocarditis.
- To compare the clinical, imaging, and immunological characteristics of COVID-19-associated myocarditis and vaccine-induced myocarditis.
Main Methods:
- Review of clinical data, cardiac biomarkers, and imaging findings (cardiac magnetic resonance) in COVID-19 patients.
- Analysis of histological data from necropsies and endomyocardial biopsies.
- Comparison of presentation and immunological mechanisms between COVID-19 and mRNA vaccine-related myocarditis.
Main Results:
- Histological evidence of acute myocarditis in COVID-19 patients is rare, with biopsies showing macrophage-predominant inflammation.
- Cardiac magnetic resonance reveals diverse patterns of myocardial involvement, including late gadolinium enhancement.
- mRNA COVID-19 vaccines are associated with an increased risk of myocarditis, differing in presentation and underlying immunology from infection-related myocarditis.
Conclusions:
- COVID-19 infection can lead to significant cardiac damage through complex mechanisms.
- Distinct clinical and immunological differences exist between COVID-19-related and mRNA vaccine-related myocarditis.
- Further research is needed to fully understand the distinct immunological pathways involved in both conditions.
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.
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