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Cited by 34Viral Infections and Immunology ResearchCOVID-19 Clinical Research StudiesKawasaki Disease and Coronary Complications

The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index.

Subacute and chronic post-covid myoendocarditis: clinical presentation, role of coronavirus persistence and autoimmune mechanisms

Open access
Blagova, O. V., Kogan, E. A., Lutokhina, Yu. A., Kukleva, A. D., Ainetdinova, D. H., Novosadov, V. M., Rud`, R. S., Zaitsev, A. Yu., Zaidenov, V. A., Kupriyanova, A. G., Alexandrova, S. А., Fomin, V. V.·2021·Kardiologiia
DOI 10.18087/cardio.2021.6.n1659
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Abstract

Aim To study clinical features of myoendocarditis and its possible mechanisms, including persistence of SARS-Cov-2 in the myocardium, in the long-term period following COVID-19.Material and methods This cohort, prospective study included 15 patients aged 47.8±13.4 years (8 men) with post-COVID myocarditis. The COVID-19 diagnosis was confirmed for all patients. Median time to seeking medical care after COVID-19 was 4 [3; 7] months. The diagnosis of myocarditis was confirmed by magnetic resonance imaging (MRI) of the heart (n=10) and by endomyocardial biopsy of the right ventricle (n=6). The virus was detected in the myocardium with PCR; immunohistochemical (IHC) study with antibody to SARS-Cov-2 was performed; anticardiac antibody level was measured; and echocardiography and Holter monitoring were performed. Hemodynamically significant coronary atherosclerosis was excluded for all patients older than 40 years.Results All patients showed a clear connection between the emergence or exacerbation of cardiac symptoms and COVID-19. 11 patients did not have any signs of heart disease before COVID-19; 4 patients had previously had moderate arrhythmia or heart failure (HF) without myocarditis. Symptoms of myocarditis emerged at 1–5 months following COVID-19. MRI revealed typical late gadolinium accumulation, signs of hyperemia, and one case of edema. The level of anticardiac antibodies was increased 3-4 times in 73 % больных. Two major clinical variants of post-COVID myocarditis were observed. 1. Arrhythmic (n=6), with newly developed extrasystole or atrial fibrillation without systolic dysfunction. 2. Decompensated variant with systolic dysfunction and biventricular HF (n=9). Mean left ventricular ejection fraction was 34.1±7.8 %, and left ventricular end-diastolic dimension was 5.8±0.7 cm. In one case, myocarditis was associated with signs of IgG4‑negative aortitis. SARS-Cov-2 RNA was found in 5 of 6 biopsy samples of the myocardium. The longest duration of SARS-Cov-2 persistence in the myocardium was 9 months following COVID-19. By using antibody to the Spike antigen and nucleocapsid, SARS-Cov-2 was detected in cardiomyocytes, endothelium, and macrophages. Five patients were diagnosed with lymphocytic myocarditis; one with giant-cell myocarditis; three patients had signs of endocarditis (infectious, lymphocytic with mural thrombosis).Conclusion Subacute/chronic post-COVID myocarditis with isolated arrhythmias or systolic dysfunction is characterized by long-term (up to 9 months) persistence of SARS-Cov-2 in the myocardium in combination with a high immune activity. Endocarditis can manifest either as infectious or as nonbacterial thromboendocarditis. A possibility of using corticosteroids and anticoagulants in the treatment of post-COVID myoendocarditis should be studied.

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Crossref · 10.18087/cardio.2021.6.n1659

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Citations

Cites

Research works printed but not linked: 1

  1. Tyrin V.P. Infective endocarditis. 2nd edition, expanded and revised. -M.: GEOTAR-Media;2013. - 368 p. ISBN 978-5-9704-2080-5

Cited by

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Metadata

Authors
Blagova, O. V., Kogan, E. A., Lutokhina, Y. A., Kukleva, A. D., Ainetdinova, D. H., Novosadov, V. M., Rud`, R. S., Zaitsev, A. Y., Zaidenov, V. A., Kupriyanova, A. G., Alexandrova, S. А., & Fomin, V. V.
Affiliations
  • Sechenov University (RU)
  • The State Education Institution of Higher Professional Training the First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
  • City Clinical Hospital № 52, Moscow, Russia
  • Moscow Regional Scientific Research Clinical Institute. MF Vladimirsky (RU)
  • Bakulev Scientific Center for Cardiovascular Surgery Russian Academy of Medical Sciences (RU)
ORCID
Venue
Kardiologiia
Publisher
APO Society of Specialists in Heart Failure
Published
2021-07-01
Volume
61
Issue
6
Pages
11-27
ISSN
  • 0022-9040 (ISSN-L)
  • 2412-5660
DOI
10.18087/cardio.2021.6.n1659
OpenAlex
W3186356897
Cited by
34
References
40
Citations by year
2026: 2 · 2025: 4 · 2024: 3 · 2023: 13 · 2022: 11 · 2021: 1
FWCI
4.69
Type
journal article
Language
ru
Open access
Licence
Locations
  • Kardiologiia (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Kawasaki Disease and Coronary Complications
Keywords
autoimmune mechanisms, cardiac arrhythmias, heart failure with reduced ejection fraction, long COVID, myocarditis, late gadolinium enhancement, endomyocardial biopsy, SARS-CoV-2 RNA
MeSH terms
COVID-19, SARS-CoV-2, COVID-19 Testing, Atrial Fibrillation, Humans, Male, Myocarditis, Myocardium, Prospective Studies, RNA, Viral, Stroke Volume, Ventricular Function, Left, Myocytes, Cardiac

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.