Abstract 16062: Acute Myocarditis and Pericarditis in Post-Acute Sequelae of COVID-19: Initial Insights From the IMPACT-COVID-19 Study

Abstract

Introduction: Myocarditis and/or pericarditis were reported in patients with Post-Acute Sequelae of COVID-19 (PASC). Goals: We aim to determine the prevalences, risk factors, and discriminative values of inflammatory biomarkers for acute myocarditis/pericarditis in patients with PASC. Methods: IMPACT-COVID-19 is an ongoing prospective longitudinal cohort enrolling adults with PASC and at least one symptom suggestive of potential cardiac disorder (dyspnea, palpitation, chest pain and dizziness) in Quebec, Canada (years 2021-ongoing). We obtained baseline inflammatory, cardiac biomarkers, electrocardiograms, echocardiograms, and cardiac magnetic resonance imaging (CMR). We defined myocarditis/pericarditis as either 1) positive Lake Louise criteria on CMR, 2) pericardial effusion or 3) chest pain with elevated cardiac biomarkers or inflammatory biomarkers. Results: The following results were based on the initial 256 patients enrolled (with a median of 279 days after their initial COVID-19 infection). Most were female (73%), and White (86%) with a mean age of 45 years. Seventy-six patients (30%) had acute myocarditis and/or pericarditis. One hundred and three patients (40%) had an emergency room (ER) visit for the index COVID infection and this was associated with an increased risk of myocarditis/ pericarditis: (odds ratio: 2.39 (95% confidence intervals: 1.21, 4.72). The ESR was elevated in patients with myocarditis/pericarditis compared to patients without myocarditis/pericarditis (18 mm/h vs 12 mm/h; p:0.02). There was no observed difference in CRP (1.85 mg/L for patients with myocarditis/pericarditis versus 1.54 mg/L for patients without myocarditis/pericarditis, p:0.51). ROC c-statistics were 0.61 for ESR and 0.49 for CRP. An ESR of ≥14 mm/h has the best predictive value for myo/pericarditis. Conclusions: Our findings suggest that clinicians should be aware that patients with PASC, especially those who required an ER visit for their COVID-19 infection, are at increased risk for acute myocarditis/pericarditis. ESR should also be considered in the diagnostic tests for PASC-related myocarditis/pericarditis.