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DOI: 10.1055/a-1539-8664
COVID-19 and Myocarditis: Findings from Cardiac Magnetic Resonance Imaging and Endomyocardial Biopsies
Funding K.K. received basic funding from the Ministry of Science, Research and Arts of the State of Baden-Württemberg (COVID-19 Funding) and from Deutsche Herzstiftung.
Abstract
Diagnosing myocarditis is still challenging due to its varying presentation ranging from none or mild symptoms to sudden cardiac death. Clinical presentation, electrocardiography, and cardiac biomarkers seem not to be sufficient for a reliable diagnosis. In fact, an unequivocal myocardial characterization is needed, applying endomyocardial biopsy (EMB) and cardiac magnetic resonance (CMR), a technique which demonstrates high accuracy to histology. Besides the assessment of functional parameters (volumes, ejection fraction), established late gadolinium enhancement and recent T1 and T2 mapping techniques including the calculation of extracellular volume fraction allow distinct myocardial tissue analysis by a noninvasive approach without the need of radiation. However, EMB is the only method which allows the identification of the underlying etiology of cardiac inflammation. Since myocardial damage and inflammation seem to be prevalent in a considerable number of patients even in the mid-term range after COVID-19, CMR and EMB seem to be adequate tools to further investigate these findings. In this article, we will (1) review current knowledge about the role of CMR in the COVID-19 pandemic and (2) report about our own EMB findings in COVID-19 patients in the Cardiopathology Center of our University Hospital.
Publication History
Received: 11 May 2021
Accepted: 27 June 2021
Article published online:
14 August 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
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References
- 1 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
- 2 Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020; 17 (05) 259-260
- 3 Imazio M, Klingel K, Kindermann I. et al. COVID-19 pandemic and troponin: indirect myocardial injury, myocardial inflammation or myocarditis?. Heart 2020; 106 (15) 1127-1131
- 4 Greulich S, Seitz A, Müller KAL. et al. Predictors of mortality in patients with biopsy-proven viral myocarditis: 10-year outcome data. J Am Heart Assoc 2020; 9 (16) e015351
- 5 Greulich S, Ferreira VM, Dall'Armellina E, Mahrholdt H. Myocardial inflammation - Are we there yet?. Curr Cardiovasc Imaging Rep 2015; 8 (03) 6
- 6 Ferreira VM, Schulz-Menger J, Holmvang G. et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol 2018; 72 (24) 3158-3176
- 7 Ojha V, Verma M, Pandey NN. et al. Cardiac magnetic resonance imaging in coronavirus disease 2019 (COVID-19): a systematic review of cardiac magnetic resonance imaging findings in 199 patients. J Thorac Imaging 2021; 36 (02) 73-83
- 8 Puntmann VO, Carerj ML, Wieters I. et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5 (11) 1265-1273
- 9 Huang L, Zhao P, Tang D. et al. Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging. JACC Cardiovasc Imaging 2020; 13 (11) 2330-2339
- 10 Zaccone G, Tomasoni D, Italia L, Lombardi CM, Metra M. Myocardial involvement in COVID-19: an interaction between comorbidities and heart failure with preserved ejection fraction. a further indication of the role of inflammation. Curr Heart Fail Rep 2021; 18 (03) 99-106
- 11 Caforio AL, Pankuweit S, Arbustini E. et al; European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34 (33) 2636-2648 , 2648a–2648d
- 12 Varga Z, Flammer AJ, Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395 (10234): 1417-1418
- 13 Bojkova D, Wagner JUG, Shumliakivska M. et al. SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes. Cardiovasc Res 2020; 116 (14) 2207-2215
- 14 Klingel K, Pöml P, Strunk J, Werthmann ML. Lethal enterovirus myocarditis in a patient with granulomatosis with polyangiitis following rituximab and high-dose steroid therapy. Eur Heart J 2021; 42 (24) 2401
- 15 Mueller KAL, Heinzmann D, Klingel K. et al. Histopathological and immunological characteristics of tachycardia-induced cardiomyopathy. J Am Coll Cardiol 2017; 69 (17) 2160-2172
- 16 Lutgens E, Atzler D, Döring Y, Duchene J, Steffens S, Weber C. Immunotherapy for cardiovascular disease. Eur Heart J 2019; 40 (48) 3937-3946