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Article

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

by
Giovanni Peretto
1,2,3,*,
Andrea Villatore
3,
Stefania Rizzo
4,
Antonio Esposito
2,3,5,
Giacomo De Luca
2,6,
Anna Palmisano
2,5,
Davide Vignale
2,5,
Alberto Maria Cappelletti
7,
Moreno Tresoldi
8,9,
Corrado Campochiaro
2,6,
Silvia Sartorelli
2,6,
Marco Ripa
9,10,
Monica De Gaspari
4,
Elena Busnardo
2,11,
Paola Ferro
11,
Maria Grazia Calabrò
12,
Evgeny Fominskiy
12,
Fabrizio Monaco
12,
Giulio Cavalli
6,
Luigi Gianolli
11,
Francesco De Cobelli
3,5,
Alberto Margonato
7,
Lorenzo Dagna
3,6,
Mara Scandroglio
12,
Paolo Guido Camici
3,
Patrizio Mazzone
1,
Paolo Della Bella
1,
Cristina Basso
4 and
Simone Sala
1,2add Show full author list remove Hide full author list
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
7
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
10
Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
11
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
 
add Show full affiliation list
 
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*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(9), 1974; https://doi.org/10.3390/jcm10091974
Submission received: 17 March 2021 / Revised: 8 April 2021 / Accepted: 22 April 2021 / Published: 4 May 2021
(This article belongs to the Special Issue Diagnosis and Management of Cardiovascular Disease (CVD) during the COVID-19 Pandemic)
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Abstract

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.
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.; et al. 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, et al. 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, Andrea Villatore, Stefania Rizzo, Antonio Esposito, Giacomo De Luca, Anna Palmisano, Davide Vignale, Alberto Maria Cappelletti, Moreno Tresoldi, Corrado Campochiaro, and et al. 2021. "The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach" Journal of Clinical Medicine 10, no. 9: 1974. https://doi.org/10.3390/jcm10091974

APA 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., ... Sala, S. (2021). The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach. Journal of Clinical Medicine, 10(9), 1974. https://doi.org/10.3390/jcm10091974

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