Characteristics of COVID-19 Myocarditis With and Without Multisystem Inflammatory Syndrome

Characteristics of COVID-19 Myocarditis With and Without Multisystem Inflammatory Syndrome

Multisystem inflammatory syndrome (MIS) is a severe complication described in a minority of patients with COVID-19. Myocarditis has been reported in patients with COVID-19, including MIS. In this study, we compared the clinical characteristics and cardiac magnetic resonance (CMR) findings of COVID-1...

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Bibliographic Details
Published in:The American journal of cardiology Vol. 168; pp. 135 - 141
Main Authors: Li, Dan Leslie, Davogustto, Giovanni, Soslow, Jonathan Harvey, Wassenaar, Jean Wang, Parikh, Amar Pradip, Chew, Joshua David, Dendy, Jeffrey Michael, George-Durrett, Kristen Marie, Parra, David Andres, Clark, Daniel Eugene, Hughes, Sean Gillette
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-04-2022
Elsevier Limited
Subjects:
Biomarkers
Cardiovascular disease
Contrast Media
Coronaviruses
COVID-19
COVID-19 - complications
Edema
Electrocardiography
Gadolinium
Heart diseases
Humans
Immunoglobulins
Inflammation
Magnetic resonance
Magnetic Resonance Imaging
Magnetic Resonance Imaging, Cine
Mortality
Myocarditis
Myocarditis - diagnostic imaging
Myocarditis - pathology
Myocardium - pathology
Patients
Polymerase chain reaction
Predictive Value of Tests
Scanners
Severe acute respiratory syndrome coronavirus 2
Software
Variables
Netherlands
Lake Louise
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Summary:Multisystem inflammatory syndrome (MIS) is a severe complication described in a minority of patients with COVID-19. Myocarditis has been reported in patients with COVID-19, including MIS. In this study, we compared the clinical characteristics and cardiac magnetic resonance (CMR) findings of COVID-19 myocarditis in patients with and without MIS. In the 330 patients with COVID-19 who were referred for CMR at our institution between July 24, 2020, to March 31, 2021, 40 patients were identified as having myocarditis, MIS myocarditis (n = 21) and non-MIS myocarditis (n = 19). MIS myocarditis was characterized by global myocardial inflammation/edema with significantly elevated native T1, whereas only regional inflammation, and edema were noted in the non-MIS group. Distinct late gadolinium enhancement (LGE) patterns—inferior myocardial involvement in non-MIS myocarditis and septal involvement in MIS myocarditis—were identified. The LGE burden was comparable between the 2 groups (5.9% vs 6.6%, MIS vs non-MIS group, p = 0.83). Myocarditis was diagnosed more frequently by CMR in the MIS group (70% vs 6.3%, MIS vs non-MIS, p <0.001). In the 20 patients with a sequential CMR study at a median 102-day follow-up, 25% had persistent myocardial edema. The LGE burden improved over time, from a median of 5.0% (interquartile range 3.4% to 7.3%) to 3.2% (interquartile range 2.0% to 3.8%; p <0.001). In conclusion, MIS and non-MIS myocarditis exhibit distinct characteristics by CMR. Persistent LGE and edema were common at follow-up CMR examination in both groups.
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ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2021.12.031