covid-19

LETTER TO THE EDITOR

Cardiology Journal

2022, Vol. 29, No. 1, 178–179

DOI: 10.5603/CJ.a2021.0155

Copyright © 2022 Via Medica

ISSN 1897–5593

eISSN 1898018X

Myocarditis: A complication of COVID-19 and long-COVID-19 syndrome as a serious threat in modern cardiology

Lukasz Szarpak123Michal Pruc3Krzysztof J. Filipiak1Julia Popieluch4Andrzej Bielski35Milosz J. Jaguszewski6Natasza Gilis-Malinowska6Francesco Chirico78Zubaid Rafique9Frank W. Peacock9
1Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
2Research Institute, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
3Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
4Students Research Club, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
5Polonia University, Czestochowa, Poland
61st Chair and Department of Cardiology, Medical University of Gdansk, Poland
7Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
8Health Service Department, Italian State Police, Milan, Italy
9Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States

This paper was guest edited by Prof. Togay Evrin

Address for correspondence: Lukasz Szarpak, Assoc. Prof., PhD, DPH, MBA, DBA, LLM, Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, ul. Solidarności 12, 03–411 Warszawa, Poland, e-mail: lukasz.szarpak@gmail.com

Received: 10.09.2021 Accepted: 14.11.2021 Early publication d ate: 19.11.2021

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

Myocarditis is the inflammation of the heart muscle and is usually a consequence of a viral infection [1]. Because this disease can cause the destruction of myocytes, it may result in cardiomyopathy, heart failure, and sudden cardiac death. Cardiovascular complications from coronavirus disease 2019 (COVID-19) are emerging [2], especially during hospitalization, and myocarditis has been identified as a cause of death in some COVID-19 patients [3]. In the current epidemiological situation of a very large number of hospitalized patients, we must consider the long-term effects of myocarditis caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initial reports based on magnetic resonance imaging studies showed 78% of patients with myocardial abnormalities and 60% with ongoing myocarditis 2 to 3 months after COVID-19 infection. High blood troponin concentrations were also found in 76% of patients, although their heart function was preserved [4]. In other studies, about 10 weeks after SARS-CoV-2 infection, 37% of patients were also diagnosed with myocarditis, despite only half of the respondents having symptoms of COVID-19 infection [5]. In contrast, the most recent reports that analyzed data for a fifth of the United States (US) population showed that males between 12 and 17 years of age most likely developed myocarditis within 3 months of SARS-CoV-2 infection, with an incidence of approximately 450 per million infections. The most recent CDC reports, indicating the number of infected teenagers in the US is the highest in all age groups, suggest that myocarditis will become a significant burden [6]. The reports also estimate a 16 times higher risk in patients with COVID-19 compared to the general population, with an incidence of COVID-19-associated myocarditis of approximately 150 cases per 100,000 [7].

In light of these numbers, cardiac complications both during and after the SARS-CoV-2 infection will become a significant burden. Currently, the only effective method of preventing COVID-19 complications is vaccination, which reduces not only the risk of infection and mortality but also its long-term complications, i.e., long-COVID-19. In a study of 971,504 fully vaccinated people, only 0.2% developed COVID-19 symptoms, and only 31 developed long-COVID-19. On the other hand, the rate of COVID-19 infections was 11% in the unvaccinated group [8].

There is a lessor need to focus on myocarditis following mRNA vaccination [9]. This is because the infection and hospitalization rates are 17 times lower when compared to the unvaccinated group [10]. In summary, it is necessary to vaccinate the whole of society as soon as possible, perform further research on myocarditis in long-COVID-19 syndrome, create effective screening systems, and provide care for people suffering from long-COVID-19 syndrome before it leads to more serious complications.

Acknowledgments

The study was supported by the ERC Research Net and by the Polish Society of Disaster Medicine.

Conflict of interest: None declared

References

  1. Pollack A, Kontorovich AR, Fuster V, et al. Viral myocarditis-diagnosis, treatment options, and current controversies. Nat Rev Cardiol. 2015; 12(11): 670–680, doi: 10.1038/nrcardio.2015.108, indexed in Pubmed: 26194549.
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  6. Singer ME, Taub IB, Kaelber DC. Risk of Myocarditis from COVID-19 Infection in People Under Age 20: A Population-Based Analysis. medRxiv. 2021, doi: 10.1101/2021.07.23.21260998, indexed in Pubmed: 34341797.
  7. Boehmer TK, Kompaniyets L, Lavery AM, et al. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020-January 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(35): 1228–1232, doi: 10.15585/mmwr.mm7035e5, indexed in Pubmed: 34473684.
  8. Antonelli M, Penfold RS, Merino J, et al. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2021 [Epub ahead of print], doi: 10.1016/S1473-3099(21)00460-6, indexed in Pubmed: 34480857.
  9. Diaz GA, Parsons GT, Gering SK, et al. Myocarditis and pericarditis after vaccination for COVID-19. JAMA. 2021; 326(12): 1210–1212, doi: 10.1001/jama.2021.13443, indexed in Pubmed: 34347001.
  10. Delahoy MJ, Ujamaa D, Whitaker M, et al. Hospitalizations Associated with COVID-19 Among Children and Adolescents — COVID-NET, 14 States, March 1, 2020-August 14, 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(36): 1255–1260, doi: 10.15585/mmwr.mm7036e2, indexed in Pubmed: 34499627.

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