Abstract 18072: Multiple Sclerosis and Covid-19-Related Myocarditis: A Brain and Heart Affectation

Abstract

Introduction: Myocarditis (MC) and multiple sclerosis (MS) are inflammatory affectations of the myocardium and the central nervous system, respectively. It has been suggested that MS and MC share similar immunological dysfunctions. MS and MC also have associations with viral infection, and SARS-CoV-2 specifically has been associated with MC, indicating that a viral infection may induce or enhance a dysfunctional immune response favored by individuals' genetic susceptibility. Hypothesis: We hypothesized that patients with preexisting MS may be more susceptible to COVID-19-related MC. Methods: A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD codes, a cohort of patients admitted for COVID-19 as the primary diagnosis (index event) was identified. The cohort then was divided into two groups based on the presence of MS upon admission. The records of both groups were compared by demographics and a panel of 16 comorbidities. Pearson's chi-square and t-test were used to compare the group's characteristics when appropriate. A Kaplan-Meier analysis was then used to compare the probability of the outcome (MC) 90 days following the index event. A p-value of <0.05 was considered significant. Results: We found a total of 2,782,278 patients admitted for COVID-19, with 24,515 (0.88%) having a history of MS. Patients with MS were younger (mean age 58 vs. 60, p<0.0001), predominantly female (73%), and had more comorbidities (Elixhauser Comorbidity Index 8.8 vs. 6.3, p<0.0001). A history of hypertension, heart failure, obesity, cerebrovascular accident, drug abuse, smoking, asthma, cancer, diabetes, MC, and MI were significantly more prevalent in the MS group. No differences in rheumatoid arthritis, CKD, and HIV were identified. COVID-19 patients with pre-existing MS were significantly at higher risk of MC, 90 days after admission (Log-Rank p=0.04). Conclusions: Despite its striking analogies to MS, the precise mechanism by which SARS-CoV-2 induces MC is unknown. Our findings highlight the likelihood that SARS-CoV-2 can induce myocardial inflammation in patients with a dysfunctional immune response. Moreover, MS patients were more exposed to established cardiovascular disease risk factors.