Myocarditis mortality with and without COVID-19: insights from a national registry
Open accessAbstract
Background: Myocarditis in context of a SARS-CoV-2 infection is vividly discussed in the literature. Real-world data however are sparse, and relevance of the myocarditis diagnosis to outcome in coronavirus disease (COVID-19) is unclear. Patients and methods: Retrospective analysis of 75,304 patients hospitalized in Germany with myocarditis between 2007 and 2020 is reported by DESTATIS. Patients hospitalized between 01/2016 and 12/2019 served as reference cohort for the COVID-19 patients hospitalized in 2020. Results: A total of 75,304 patients were hospitalized between 2007 and 2020 (age 42.5 years, 30.1% female, hospital mortality 2.4%). In the reference cohort, 24,474 patients (age 42.8 years, 29.5% female, hospital mortality 2.2%) were registered. In 2020, annual myocarditis hospitalizations dropped by 19.6% compared to reference (4921 vs. 6119 annual hospitalization), of which 443/4921 (9.0%) were connected to COVID-19. In 2020, hospital mortality of myocarditis in non-COVID-19 patients increased significantly compared to reference (2.9% vs. 2.2%, p = 0.008, OR 1.31, 95% CI 1.08–1.60). In COVID-19 myocarditis, hospital mortality was even higher compared to reference (13.5% vs. 2.2%, p < 0.001, OR 6.93, 95% CI 5.18–9.18). Conclusion: The burden of patients with myocarditis and COVID-19 in 2020 was low. Hospital mortality was more than sixfold higher in patients with myocarditis and COVID-19 compared to those with myocarditis but without COVID-19. Graphical abstract:
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Myocarditis occurs predominantly in male patients aged 12 to 40 years regardless of whether the cause was virus-like SARS-CoV-2 or associated with a vaccine.
“Importantly, the findings highlight that myocarditis occurs predominantly in male patients aged 12 to 40 years regardless of whether the cause was due to a virus-like SARS-CoV-2 or associated with a vaccine-a demographic that has been reported before COVID-19.”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [103]
Table 1 reports a male majority in both the COVID-19 and non-COVID-19 myocarditis cohorts. It does not establish that patients were predominantly aged 12–40; their mean ages were 53.4 and 45.8 years, respectively. The Discussion says vaccine-associated myocarditis was excluded as a potential origin in this registry, so the paper cannot support the vaccine comparison. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMyocarditis typically occurs more often in young men aged 16 to 30 years, and the sex ratio for COVID-19 studies is typically observed to be 60% men to 40% women.
“Myocarditis typically occurs more often in young men aged 16 to 30 years, and the sex ratio for COVID-19 studies is typically observed to be 60% men to 40% women.”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [103]
The Myocarditis cohort section reports that 30.1% of hospitalized patients were female, supporting male predominance. But Table 1 (listed under Conclusion; page unavailable) gives a mean age of 42.5 years overall and 53.4 years for patients with COVID-19 and myocarditis; it does not establish that myocarditis typically occurs at ages 16–30. The COVID-19 cohort was 33.86% female, not the claimed 40%, and one cohort cannot establish a typical ratio across COVID-19 studies. (LLM, conf=0.87)
Experimental — accuracy not yet measuredCOVID-19-associated myocarditis occurs more often in men than women (60%-70% men to 30%-40% women).
“Similarly, myocarditis associated with COVID-19 occurs more often in men than in women (60%-70% men to 30%-40% women). 103-105”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [103]
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References 37 · Cited by 23
Research works printed but not linked: 3
- Bowles NE, Ni J, Kearney DL et al (2003) Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 42:466-472. https:// doi. org/ 10. 1016/ s0735-1097(03) 00648-x · DOI
- Kawakami R, Sakamoto A, Kawai K et al (2021) Pathological evidence for SARS-CoV-2 as a cause of myocarditis: JACC review topic of the week. J Am Coll Cardiol 77:314-325. https:// doi. org/ 10. 1016/j. jacc. 2020. 11. 031 · DOI
- Daniels CJ, Rajpal S, Greenshields JT et al (2021) Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: results from the big ten COVID-19 cardiac registry. JAMA Cardiol 6:1078-1087. https:// doi. org/ 10. 1001/ jamac ardio. 2021. 2065 · DOI
- Authors
- Bemtgen, X., Kaier, K., Rilinger, J., Rottmann, F., Supady, A., von zur Mühlen, C., Westermann, D., Wengenmayer, T., & Staudacher, D. L.
- Affiliations
- University of Freiburg (DE)
- Corresponding author
- Bemtgen, Xavier
- ORCID
- Venue
- Clinical Research in Cardiology
- Published
- 2022-12-24
- Volume
- 113
- Issue
- 2
- Pages
- 216-222
- ISSN
- 1861-0684 (ISSN-L)
- 1861-0692
- PMC
- PMC9789728
- OpenAlex
- W4312204963
- Cited by
- 23
- References
- 37
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 4 · 2023: 10
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Clinical Research in Cardiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Universitätsklinikum Freiburg
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Keywords
- myocarditis, COVID-19 pandemic, SARS-CoV-2, in-hospital mortality, real-world data
- MeSH terms
- COVID-19, SARS-CoV-2, Adult, Female, Hospitalization, Humans, Male, Myocarditis, Registries, Retrospective Studies, Hospital Mortality
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