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The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach

1
Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
2
Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
3
School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy
4
Department of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, 35128 Padua, Italy
5
Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
6
Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Department of Clinical Cardiology and Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
8
Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
9
COVID-19 Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
12
Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Andrea Igoren Guaricci
J. Clin. Med. 2021, 10(9), 1974; https://doi.org/10.3390/jcm10091974
Received: 17 March 2021 / Revised: 8 April 2021 / Accepted: 22 April 2021 / Published: 4 May 2021
Background. Myocarditis lacks systematic characterization in COVID-19 patients. Methods. We enrolled consecutive patients with newly diagnosed myocarditis in the context of COVID-19 infection. Diagnostic and treatment strategies were driven by a dedicated multidisciplinary disease unit for myocarditis. Multimodal outcomes were assessed during prospective follow-up. Results. Seven consecutive patients (57% males, age 51 ± 9 y) with acute COVID-19 infection received a de novo diagnosis of myocarditis. Endomyocardial biopsy was of choice in hemodynamically unstable patients (n = 4, mean left ventricular ejection fraction (LVEF) 25 ± 9%), whereas cardiac magnetic resonance constituted the first exam in stable patients (n = 3, mean LVEF 48 ± 10%). Polymerase chain reaction (PCR) analysis revealed an intra-myocardial SARS-CoV-2 genome in one of the six cases undergoing biopsy: in the remaining patients, myocarditis was either due to other viruses (n = 2) or virus-negative (n = 3). Hemodynamic support was needed for four unstable patients (57%), whereas a cardiac device implant was chosen in two of four cases showing ventricular arrhythmias. Medical treatment included immunosuppression (43%) and biological therapy (29%). By the 6-month median follow-up, no patient died or experienced malignant arrhythmias. However, two cases (29%) were screened for heart transplantation. Conclusions. Myocarditis associated with acute COVID-19 infection is a spectrum of clinical manifestations and underlying etiologies. A multidisciplinary approach is the cornerstone for tailored management. View Full-Text
Keywords: myocarditis; COVID-19; SARS-CoV-2; ventricular arrhythmias; endomyocardial biopsy; cardiac magnetic resonance; multidisciplinary; immunosuppression; inflammation myocarditis; COVID-19; SARS-CoV-2; ventricular arrhythmias; endomyocardial biopsy; cardiac magnetic resonance; multidisciplinary; immunosuppression; inflammation
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MDPI and ACS Style

Peretto, G.; Villatore, A.; Rizzo, S.; Esposito, A.; De Luca, G.; Palmisano, A.; Vignale, D.; Cappelletti, A.M.; Tresoldi, M.; Campochiaro, C.; Sartorelli, S.; Ripa, M.; De Gaspari, M.; Busnardo, E.; Ferro, P.; Calabrò, M.G.; Fominskiy, E.; Monaco, F.; Cavalli, G.; Gianolli, L.; De Cobelli, F.; Margonato, A.; Dagna, L.; Scandroglio, M.; Camici, P.G.; Mazzone, P.; Della Bella, P.; Basso, C.; Sala, S. The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach. J. Clin. Med. 2021, 10, 1974. https://doi.org/10.3390/jcm10091974

AMA Style

Peretto G, Villatore A, Rizzo S, Esposito A, De Luca G, Palmisano A, Vignale D, Cappelletti AM, Tresoldi M, Campochiaro C, Sartorelli S, Ripa M, De Gaspari M, Busnardo E, Ferro P, Calabrò MG, Fominskiy E, Monaco F, Cavalli G, Gianolli L, De Cobelli F, Margonato A, Dagna L, Scandroglio M, Camici PG, Mazzone P, Della Bella P, Basso C, Sala S. The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach. Journal of Clinical Medicine. 2021; 10(9):1974. https://doi.org/10.3390/jcm10091974

Chicago/Turabian Style

Peretto, Giovanni; Villatore, Andrea; Rizzo, Stefania; Esposito, Antonio; De Luca, Giacomo; Palmisano, Anna; Vignale, Davide; Cappelletti, Alberto M.; Tresoldi, Moreno; Campochiaro, Corrado; Sartorelli, Silvia; Ripa, Marco; De Gaspari, Monica; Busnardo, Elena; Ferro, Paola; Calabrò, Maria G.; Fominskiy, Evgeny; Monaco, Fabrizio; Cavalli, Giulio; Gianolli, Luigi; De Cobelli, Francesco; Margonato, Alberto; Dagna, Lorenzo; Scandroglio, Mara; Camici, Paolo G.; Mazzone, Patrizio; Della Bella, Paolo; Basso, Cristina; Sala, Simone. 2021. "The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach" J. Clin. Med. 10, no. 9: 1974. https://doi.org/10.3390/jcm10091974

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