Systematic Review of COVID-19 Related Myocarditis: Insights on Management and Outcome
Open accessAbstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as COVID-19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID-19 are widely variable and range from asymptomatic infection to multi-organ failure and death. Like other viral illnesses, acute myocarditis has been reported to be associated with COVID-19 infection. However, guidelines for the diagnosis of COVID-19 myocarditis have not been established. Methods Using a combination of search terms in the PubMed/Medline, Ovid Medline and the Cochrane Library databases and manual searches on Google Scholar and the bibliographies of articles identified, we reviewed all cases reported in the English language citing myocarditis associated with COVID-19 infection. Results Fourteen records comprising a total of fourteen cases that report myocarditis/myopericarditis secondary to COVID-19 infection were identified. There was a male predominance (58%), with the median age of the cases described being 50.4 years. The majority of patients did not have a previously identified comorbid condition (50%), but of those with a past medical history, hypertension was most prevalent (33%). Electrocardiogram findings were variable, and troponin was elevated in 91% of cases. Echocardiography was performed in 83% of cases reduced function was identified in 60%. Endotracheal intubation was performed in the majority of cases. Glucocorticoids were most commonly used in treatment of myocarditis (58%). Majority of patients survived to discharge (81%) and 85% of those that received steroids survived to discharge. Conclusion Guidelines for diagnosis and management of COVID-19 myocarditis have not been established and our knowledge on management is rapidly changing. The use of glucocorticoids and other agents including IL-6 inhibitors, IVIG and colchicine in COVID-19 myocarditis is debatable. In our review, there appears to be favorable outcomes related to myocarditis treated with steroid therapy. However, until larger scale studies are conducted, treatment approaches have to be made on an individualized case-by-case basis.
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Successful application of anti-inflammatory approaches in patients with COVID-19 has been reported, likely because of the overwhelming proinflammatory and cytokine response observed early after SARS-CoV-2 infection.
“Successful application of anti-inflammatory approaches in patients with COVID-19 has been reported in the literature, likely because of the overwhelming proinflammatory and cytokine response observed early after SARS-CoV-2 infection.”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [80]
The Discussion reports favorable outcomes with anti-inflammatory treatments in some COVID-19 patients, including reduced mortality with dexamethasone in ventilated patients, and describes inflammation and cytokine release as a possible mechanism of injury. It does not establish that an overwhelming cytokine response occurs early after infection or that this explains the reported treatment success; it notes that interferon release is delayed in early infection. Page numbers were not available in our copy. (LLM, conf=0.84)
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COVID-19, Myocarditis and Pericarditis
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- Authors
- Sawalha, K., Abozenah, M., Kadado, A. J., Battisha, A., Al-Akchar, M., Salerno, C., Hernandez-Montfort, J., & Islam, A. M.
- Affiliations
- Baystate Medical Center (US)
- Corresponding author
- Sawalha, Khalid
- ORCID
- Venue
- Cardiovascular Revascularization Medicine
- Publisher
- Elsevier BV
- Published
- 2021-02
- Volume
- 23
- Pages
- 107-113
- ISSN
- 1553-8389 (ISSN-L)
- PMC
- PMC7434380
- OpenAlex
- W3049112029
- Cited by
- 217
- References
- 44
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 20 · 2023: 50 · 2022: 67 · 2021: 66 · 2020: 3
- FWCI
- 7.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cardiovascular revascularization medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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
- COVID-19 pandemic, SARS-CoV-2, myocarditis, myopericarditis, glucocorticoid therapy, IL-6 inhibitors, intravenous immunoglobulin, colchicine, troponin elevation, treatment outcomes, diagnosis
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Adult, Aged, Female, Glucocorticoids, Humans, Male, Middle Aged, Myocarditis, Young Adult, Antibodies, Monoclonal, Humanized
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