Background. Myocarditis lacks systematic characterization in COVID-19 patients. Methods. We enrolled consecutive patients with newly diagnosed myocarditis in the context of COVID-19 infection. Diagnostic and treatment strategies were driven by a dedicated multidisciplinary disease unit for myocarditis. Multimodal outcomes were assessed during prospective follow-up. Results. Seven consecutive patients (57% males, age 51 ± 9 y) with acute COVID-19 infection received a de novo diagnosis of myocarditis. Endomyocardial biopsy was of choice in hemodynamically unstable patients ( n = 4, mean left ventricular ejection fraction (LVEF) 25 ± 9%), whereas cardiac magnetic resonance constituted the first exam in stable patients ( n = 3, mean LVEF 48 ± 10%). Polymerase chain reaction (PCR) analysis revealed an intra-myocardial SARS-CoV-2 genome in one of the six cases undergoing biopsy: in the remaining patients, myocarditis was either due to other viruses ( n = 2) or virus-negative ( n = 3). Hemodynamic support was needed for four unstable patients (57%), whereas a cardiac device implant was chosen in two of four cases showing ventricular arrhythmias. Medical treatment included immunosuppression (43%) and biological therapy (29%). By the 6-month median follow-up, no patient died or experienced malignant arrhythmias. However, two cases (29%) were screened for heart transplantation. Conclusions. Myocarditis associated with acute COVID-19 infection is a spectrum of clinical manifestations and underlying etiologies. A multidisciplinary approach is the cornerstone for tailored management.
【저자키워드】 COVID-19, SARS-CoV-2, Inflammation, Immunosuppression, Endomyocardial biopsy, myocarditis, cardiac magnetic resonance, ventricular arrhythmias, Multidisciplinary, 【초록키워드】 Treatment, therapy, Infection, Diagnosis, outcome, virus, polymerase chain reaction, PCR, COVID-19 infection, SARS-CoV-2 genome, management, Patient, age, Follow-up, disease, Arrhythmias, patients, COVID-19 patients, Analysis, treatment strategy, clinical manifestation, Support, Ejection fraction, acute COVID-19, LVEF, de novo, approach, males, etiologies, enrolled, lack, died, diagnosed, screened, median, driven by, consecutive patient, ventricular, were assessed, 【제목키워드】 Spectrum,