Myocardite à COVID-19 : « à propos d'une série monocentrique de 33 cas »

Abstract

IntroductionThe world is experiencing a pandemic linked to the respiratory spread of SARS-CoV2 which can affect the heart with elevated troponins, ECG abnormalities and kinetic disturbances in echocardiography, of ischemic or non-ischemic origin (most often fulminant myocarditis). ObjectiveTo describe the evolutionary modalities of post-COVID-19 myocarditis and to identify factors of poor ejection fraction (EF) recovery under treatment of heart failure. MethodMonocentric observational study including patients with post-COVID-19 non-fulminant myocarditis confirmed by cardiac MRI. These patients were divided into 2 groups according to the evolution of their EF at 3 months (EF > 50% vs EF < 50%). Results33 patients (19♂/14♀) aged from 30 to 61 were included, all of whom had repolarization disorder; mean EF at baseline was 44.3% (30–52%) with a troponin level 480 times normal (20–2100). Conventional treatment for heart failure was initiated in all patients with clinical, electrical and echocardiographic monitoring at 1 and 3 months. A significant improvement (EF > 50%) was observed in 29 patients. Gender, congestive signs, electrical and angiographic abnormalities do not seem to influence the evolution of EF (P > 0.10). Age > 60 years, troponins > 1200 times normal, pericardial effusion and a combined criterion of the three seem to be associated with poor evolution of EF (P at 0.07, 0.02, 0.035 and 0.01 respectively). DiscussionNon-fulminant post-COVID-19 myocarditis have a good prognosis (EF recovery in 87.88%). Factors of poor recovery are age > 60 years, elevated troponins, appearance of pericardial effusion and the combined criterion of the three. ConclusionNon-fulminant post-COVID-19 myocarditis seems to have a favorable course. Patients presenting factors of poor evolution had to have a longer follow-up.