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Cited by 227Viral Infections and Immunology ResearchCOVID-19 Clinical Research StudiesTakotsubo Cardiomyopathy and Associated Phenomena

Prevalence, Characteristics, and Outcomes of COVID-19–Associated Acute Myocarditis

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Ammirati, Enrico, Lupi, Laura, Palazzini, Matteo, Hendren, Nicholas S., Grodin, Justin L., Cannistraci, Carlo V., Schmidt, Matthieu, Hekimian, Guillaume +48 more·2022·Circulation
DOI 10.1161/circulationaha.121.056817PMC PMC8989611
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Abstract

Background: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19–associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. Methods: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19–associated AM. Results: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19–associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia ( P =0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P <0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). Conclusions: AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.

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  • A separate study in the United States and Europe estimated 240 cases per 100,000 individuals of definite or probable myocarditis and 410 cases per 100,000 individuals for possible myocarditis.

    “A separate study in the United States and Europe estimated 240 cases/100 000 individuals of definite or probable myocarditis and 410 cases/100 000 individuals for possible myocarditis (Table 1).”

    From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [92]

    The Estimation of Prevalence of COVID-19 AM section (p. 4) reports 2.4 definite/probable cases and 4.1 cases including possible cases per 1,000 patients hospitalized with COVID-19—equivalent to 240 and 410 per 100,000. The citing sentence omits the hospitalized-with-COVID-19 denominator and presents 410 as the rate for possible myocarditis alone, rather than the rate including definite/probable cases. (LLM, conf=0.91)

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Authors
Ammirati, E., Lupi, L., Palazzini, M., Hendren, N. S., Grodin, J. L., Cannistraci, C. V., Schmidt, M., Hekimian, G., Peretto, G., Bochaton, T., Hayek, A., Piriou, N., Leonardi, S., Guida, S., Turco, A., Sala, S., Uribarri, A., Van de Heyning, C. M., Mapelli, M., Campodonico, J., Pedrotti, P., Barrionuevo Sánchez, M. I., Ariza Sole, A., Marini, M., Matassini, M. V., Vourc’h, M., Cannatà, A., Bromage, D. I., Briguglia, D., Salamanca, J., Diez-Villanueva, P., Lehtonen, J., Huang, F., Russel, S., Soriano, F., Turrini, F., Cipriani, M., Bramerio, M., Di Pasquale, M., Grosu, A., Senni, M., Farina, D., Agostoni, P., Rizzo, S., De Gaspari, M., Marzo, F., Duran, J. M., Adler, E. D., Giannattasio, C., Basso, C., McDonagh, T., Kerneis, M., Combes, A., Camici, P. G., de Lemos, J. A., & Metra, M.
Affiliations
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
  • University of Brescia (IT)
  • The University of Texas Southwestern Medical Center (US)
  • Center for Systems Biology Dresden (DE)
  • Sorbonne Université (FR)
  • Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive–Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié–Salpêtrière, France (M. Schmidt, G.H., A. Combes).
  • Vita-Salute San Raffaele University (IT)
  • Hospices Civils de Lyon (FR)
  • Centre National de la Recherche Scientifique (FR)
  • University of Pavia (IT)
  • Instituto de Salud Carlos III (ES)
  • Department of Cardiology, Antwerp University Hospital, and Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton Research Group, Antwerp University, Belgium (C.M.V.d.H.).
  • University of Milan (IT)
  • Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d’Investigació Biomèdica de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, L’Hospotalet del Llobregat, Barcelona, Spain (M.I.B.S., A.A.S.).
  • Azienda Ospedaliero-Universitaria delle Marche (IT)
  • Department of Anesthesiology and Surgical Intensive Care, Hôpital Laennec, University Hospital of Nantes, France (M.V.).
  • School of Cardiovascular Medicine and Sciences, King’s College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).
  • King's College London (GB)
  • Humanitas Mater Domini (IT)
  • Hospital Universitario de La Princesa (ES)
  • Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.).
  • Helsinki University Hospital (FI)
  • Hôpital Foch (FR)
  • Ospedale Civile di Baggiovara, Modena, Italy (F.T.).
  • Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra).
  • Ospedale Papa Giovanni XXIII (IT)
  • University of Padua (IT)
  • Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.).
  • Ospedale Infermi di Rimini (IT)
  • University of California San Diego (US)
  • Sorbonne Université, ACTION Study Group, Institut National de la Santé et de la Recherche Médicale UMRS1166, Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (M.K.).
  • Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.).
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-04-12
Volume
145
Issue
15
Pages
1123-1139
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.121.056817
PMC
PMC8989611
OpenAlex
W4223451229
Cited by
227
References
5
Citations by year
2026: 16 · 2025: 35 · 2024: 57 · 2023: 90 · 2022: 29
FWCI
36.70
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • BOA (University of Milano-Bicocca) (submittedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • Padua Research Archive (University of Padova) (submittedVersion, other-oa)
Funders
National Institute for Health and Care Research (CL‐2016‐17‐001)
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, acute myocarditis, prevalence, in-hospital mortality, mechanical circulatory support, pneumonia, corticosteroids, left ventricular ejection fraction, cardiac magnetic resonance imaging, endomyocardial biopsy, troponin, inotropic support, hospitalized patients, long-term outcomes, risk factors, comorbidities
MeSH terms
COVID-19, SARS-CoV-2, Adult, Female, Humans, Male, Myocarditis, Retrospective Studies, Stroke Volume, Prevalence, Ventricular Function, Left

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