Table 2.
Fulminant COVID-19–Related Myocarditis Findings
| na | All Patients (N = 38) | MIS-A− (n = 13) | MIS-A+ (n = 25) | P Value | |
|---|---|---|---|---|---|
| Clinical symptoms | |||||
| Chest pain | 18 (47) | 9 (69) | 9 (36) | 0.09 | |
| Faintness | 4 (10) | 4 (31) | 0 (0) | 0.01 | |
| Syncope | 2 (5) | 1 (8) | 1 (4) | 1.0 | |
| Sudden death | 1 (3) | 1 (8) | 0 (0) | 0.3 | |
| Laboratory findings | |||||
| Troponin, ng/mL | 526 (224-1,227) | 441 (177-1,089) | 712 (217-2,025) | 0.2 | |
| Highest value in ICU | 1,300 (486-4,750) | 2,836 (450-9,634) | 1,000 (471-3,036) | 0.2 | |
| NT-proBNP, ng/L | 1 | 9,931 (2,367-23,934) | 2,755 (1,044-8,271) | 12,525 (7,000-32,500) | 0.007 |
| Creatine phosphokinase, UI/L | 312 (131-1,150) | 586 (388-1,802) | 190 (115-435) | 0.003 | |
| Electrocardiogram findings | |||||
| Normal electrocardiogram | 14 (37) | 5 (38) | 9 (36) | 1.0 | |
| Sinus rhythm | 36 (95) | 12 (92) | 24 (96) | 1.0 | |
| Atrial fibrillation | 2 (5) | 1 (8) | 1 (4) | 1.0 | |
| ST-segment elevation | 10 (26) | 6 (46) | 4 (16) | 0.06 | |
| ST-segment depression | 6 (16) | 2 (15) | 4 (16) | 1.0 | |
| Negative T wave | 10 (26) | 1 (8) | 9 (36) | 0.1 | |
| Complete heart block | 1 (3) | 0 (0) | 1 (4) | 1.0 | |
| Bundle branch block | 5 (13) | 1 (8) | 4 (16) | 0.6 | |
| Ventricular rhythm disorders | 3 (8) | 3 (23) | 0 (0) | 0.03 | |
| Echocardiography findings | |||||
| LVEF, % | |||||
| First evaluation | 30 (20-45) | 30 (15-45) | 30 (25-42) | 0.5 | |
| On ICU admission | 20 (14-37) | 10 (5-30) | 30 (15-45) | 0.01 | |
| Lowest value in ICU | 20 (10-30) | 10 (5-25) | 20 (15-30) | 0.02 | |
| ICU discharge | 42 (30-54) | 35 (17-57) | 45 (35-52) | 0.1 | |
| Last follow-up | 10 | 60 (50-64) | 59 (44-60) | 60 (50-65) | 0.5 |
| LVOT VTI, cm | |||||
| First evaluation | 12 (8-16) | 8 (7-17) | 12 (9-15) | 0.2 | |
| On ICU admission | 11 (6-15) | 5 (2-9) | 13 (10-17) | <0.0001 | |
| ICU discharge | 17 (12-18) | 12 (7-18) | 17 (15-19) | 0.08 | |
| Ventricular hypertrophy | 16 (42) | 8 (62) | 8 (32) | 0.1 | |
| Ventricular dilation | 5 (13) | 2 (15) | 3 (12) | 1.0 | |
| LVEDD, mm | 50 (47-56) | 48 (46-55) | 50 (47-56) | 0.7 | |
| Right ventricular involvement | 15 (39) | 7 (54) | 8 (32) | 0.3 | |
| TAPSE, mm | 20 | 14 (12-17) | 12 (8-16) | 14 (12-17) | 0.2 |
| S wave, cm/s | 21 | 9 (7-11) | 6 (1-11) | 10 (8-11) | 0.1 |
| Mitral valve regurgitation | 9 (24) | 3 (23) | 6 (24) | 1.0 | |
| Aortic valve regurgitation | 3 (8) | 0 (0) | 1 (4) | 1.0 | |
| Tricuspid valve regurgitation | 3 (8) | 0 (0) | 3 (12) | 0.5 | |
| Pericardial effusion | 15 (39) | 8 (62) | 7 (28) | 0.08 | |
| Pericardiocentesis | 4 (10) | 4 (31) | 0 (0) | 0.01 | |
| CMR findings | |||||
| Number performed in ICU/hospital | 26 (68) | 5 (38) | 21 (84) | ||
| Time from symptoms to CMR, days | 7 (4-18) | 16 (9-33) | 5 (4-10) | ||
| Myocardial edema | 19/26 (73) | 3/5 (60) | 16/21 (76) | 0.6 | |
| Late gadolinium enhancement | 14/26 (54) | 4/5 (80) | 10/21 (48) | 0.3 | |
| Myocarditis classificationb | |||||
| Definite myocarditis | 29 (76) | 9 (69) | 20 (80) | ||
| Probable myocarditis | 9 (24) | 4 (31) | 5 (20) | ||
| Pathology | 2 (5) | 2 (15) | 1 (4) | ||
| Imaging | |||||
| Cardiac magnetic resonance | 22 (58) | 4 (31) | 18 (72) | ||
| Echocardiography WMA | 32 (84) | 13 (100) | 24 (96) | ||
| Coronary angiography performed and normal | 10 (26) | 6 (46) | 4 (16) | ||
| Electrocardiogram | 23 (60) | 8 (61) | 15 (60) | ||
| Syndrome | 38 (100) | 13 (100) | 25 (100) | ||
| Biomarkers | 38 (100) | 13 (100) | 25 (100) |
Values are median (IQR), n (%), or n/N (%), unless otherwise indicated. Continuous variables are compared with Wilcoxon’s rank test; categorical variables are compared with Fisher exact test.
CMR = cardiac magnetic resonance; LVEDD = left ventricular end-diastolic diameter; LVEF = left ventricular ejection fraction; LVOT VTI = left ventricle outflow tract velocity-time integral; NT-proBNP = N-terminal pro–B-type natriuretic peptide; TAPSE = tricuspid annular plane systolic excursion; WMA = wall motion abnormality; other abbreviations as in Table 1.
a
Number of missing values.
b
According to the myocarditis classification proposed by Bonaca et al.11