Myocarditis Associated With Greater Oxygen Therapy Needs, Longer Hospitalization in Patients With COVID-19

Myocarditis is a potentially severe cardiovascular (CV) complication of coronavirus disease 2019 (COVID-19) and is associated with more severe infection, greater need for oxygen therapy, and longer hospitalization in patients with the novel coronavirus infection, a study in Medicine suggests.

This retrospective study examined 1169 consecutive patients with COVID-19 who were admitted to 3 medicine wards in Italy. Given the lack of data on the incidence and clinical significance of myocarditis in this patient population, the researchers examined the rate of suspect myocarditis associated with COVID-19. Additionally, the investigators examined associated in-hospital death, length of hospital stay, and comorbidities in these patients.

Approximately 1% (n=12) of the patients with COVID-19 had suspected acute myocarditis. The mean age of the patients with suspected acute myocarditis was 76 years, and up to 41.7% of patients were men.

A total of 3 (25%) patients died during an average of 38 days of hospitalization. Among patients with suspected myocarditis, 66.7% (n=8) had a history of CV disease (CVD). Additionally, more than half (58.33%) of patients with COVID-19 and myocarditis had other comorbidities, including diabetes, chronic obstructive pulmonary disease, and renal insufficiency.

Compared with patients with COVID-19 but without myocarditis, patients with COVID-19 and myocarditis had a significantly greater need for oxygen support (27% vs 75%, respectively; P =.0009) and higher prevalence of CVD (28.8% vs 66.7%; P =.01). Also, patients with suspected myocarditis were older (mean, 76 vs 71 years; P =.10) and had a significantly longer hospital stay (mean, 38 vs 29.5 days; P =.01). Myocarditis was also associated with a lower mean interleukin-6 (IL-6) value compared with patients without myocarditis (26 vs 65.7 pg/mL, respectively; P =.10).

The primary limitations of this study included its retrospective design and the overall small sample size.

Given that the study found an association between myocarditis, comorbidities, and lower levels of IL-6, the researchers suggest “this finding deserves to be further investigated to better understand myocarditis prognostic and pathogenetic factors and to evaluate a specific target therapy.”

Reference

Laganà N, Cei M, Evangelista I, et al. Suspected myocarditis in patients with COVID-19: a multicenter case series. Medicine (Baltimore). 2021;100(8):e24552. doi:10.1097/MD.0000000000024552