Myocardial inflammation in COVID-19 has been documented. Its pathogenesis is not fully elucidated, but the two main theories foresee a direct role of ACE2 receptor and a hyperimmune response, which may also lead to isolated presentation of COVID-19-mediated myocarditis. The frequency and prognostic impact of COVID-19-mediated myocarditis is unknown. This review aims to summarise current evidence on this topic. We performed a systematic review of MEDLINE and Cochrane Library (1/12/19–30/09/20). We also searched clinicaltrials.gov for unpublished studies testing therapies with potential implication for COVID-19-mediated cardiovascular complication. Eligible studies had laboratory confirmed COVID-19 and a clinical and/or histological diagnosis of myocarditis by ESC or WHO/ISFC criteria. Reports of 38 cases were included (26 male patients, 24 aged < 50 years). The first histologically proven case was a virus-negative lymphocytic myocarditis; however, biopsy evidence of myocarditis secondary to SARS-CoV-2 cardiotropism has been recently demonstrated. Histological data was found in 12 cases (8 EMB and 4 autopsies) and CMR was the main imaging modality to confirm a diagnosis of myocarditis (25 patients). There was a substantial variability in biventricular systolic function during the acute episode and in therapeutic regimen used. Five patients died in hospital. Cause-effect relationship between SARS-CoV-2 infection and myocarditis is difficult to demonstrate. However, current evidence demonstrates myocardial inflammation with or without direct cardiomyocyte damage, suggesting different pathophysiology mechanisms responsible of COVID-mediated myocarditis. Established clinical approaches should be pursued until future evidence support different actions. Large multicentre registries are advisable to elucidate further. Supplementary information The online version contains supplementary material available at 10.1007/s10741-021-10087-9.
【저자키워드】 COVID-19, SARS-CoV-2, coronavirus, cardiac injury, myocarditis, myocardial damage, cardiac damage, 2019nCoV, 【초록키워드】 Inflammation, therapy, Pathogenesis, SARS-COV-2 infection, hospital, Diagnosis, systematic review, ACE2 receptor, Laboratory, pathophysiology, therapeutic, male, multicentre, Myocardial inflammation, prognostic, information, patients, mechanism, Evidence, Frequency, criteria, regimen, Autopsies, Support, Topic, supplementary material, Variability, Cochrane Library, report, approach, responsible, performed, searched, demonstrated, histological, EMB, hyperimmune response, patients died, 【제목키워드】 systematic review,