Trends of Acute Pericarditis Among Patients With Long COVID-19 Syndrome

Patients with an autoimmune or allergic disorder and long COVID-19 are increased risk for acute pericarditis.

Acute pericarditis may be an outcome for some patients with long COVID-19 syndrome, especially among patients with autoimmune and allergic disorders. These findings, from a retrospective study, were published in the International Journal of Cardiology.

Data for this study were collected at ambulatory centers devoted to identifying and treating patients with long COVID-19 syndrome in Italy and Sweden. Patients (N=180) previously diagnosed with COVID-19 who were experiencing persistent or new-onset symptoms 12 weeks or longer after a negative COVID-19 test received a complete physical examination. The subset of patients with suspected cardiac involvement also received a complete cardiovascular examination, including echocardiography. Prevalence and risk factors associated with acute pericarditis were assessed.

The patients had a mean age of 48±16 years, 62% were women, 38% were vaccinated for COVID-19, 16% had autoimmune and allergic disorders, and 2% had coronary artery disease. The median duration of SARS-CoV-2 positivity was 21 (IQR, 14-41) days and duration of COVID-19 symptoms was 131 (IQR, 94-255) days.

At the examination, the most common symptoms were shortness of breath (52%), heart palpitations or arrhythmia (37%), and chest pain or discomfort (34%). At laboratory testing, 10% had abnormal C-reactive protein, 9% abnormal erythrocyte sedimentation rate, and 9% abnormal D-dimer.

Overall, 39 patients had acute pericarditis. The patients with acute pericarditis were mostly women (P =.0120), had autoimmune or allergic disorders (P <.0001), had longer duration of COVID-19 symptoms (P =.0106), had chest pain or discomfort (P <.0001), had heart palpitations or arrhythmias (P <.001), had abnormal C-reactive protein concentrations (P =.00101), and had abnormal erythrocyte sedimentation rate (P <.0001) compared with patients without acute pericarditis.

Our findings suggest a high prevalence of acute pericarditis in patients with long COVID-19 syndrome.

After a diagnosis of acute pericarditis, patients were prescribed colchicine (n=26), nonsteroidal anti-inflammatory drugs (NSAIDs; n=25), and corticosteroids (n=8). A total of 7 NSAID recipients were nonresponders and were switched to corticosteroids.

Most (n=33) patients recovered from acute pericarditis after 1 to 4 weeks of therapy.  After 1 month or more of relief from acute pericarditis symptoms, recurrence occurred among 10 patients. These recurrences were attributed to idiopathic pericarditis (n=6), COVID-19 vaccination (n=5), and/or COVID-19 recurrence (n=1).

Risk for acute pericarditis was associated with autoimmune or allergic disorders (odds ratio [OR], 4.147; 95% CI, 1.466-11.728; P =.007) and symptoms of heart palpitations or arrhythmia (OR, 3.748; 95% CI, 1.565-8.976; P =.003).

The results of this study may not be generalizable to settings that are not focused on long COVID-19 syndrome.

“Our findings suggest a high prevalence of acute pericarditis in patients with long COVID-19 syndrome,” the study authors wrote. “Autoimmune and allergic disorders, and palpitations/arrhythmias were frequently associated with pericardial disease.”

References:

Dini FL, Baldini U, Bytyçi I, Pugliese NR, Bajraktair G, Henein MY. Acute pericarditis as a major clinical manifestation of long COVID-19 syndrome. Int J Cardiol. Published online December 9, 2022. doi:10.1016/j.ijcard.2022.12.019