Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
Eur J Clin Invest. 2021 Nov;51(11):e13679. doi: 10.1111/eci.13679. Epub 2021 Sep 18.
COVID-19 has a wide spectrum of cardiovascular sequelae including myocarditis and pericarditis; however, the prevalence and clinical impact are unclear. We investigated the prevalence of new-onset myocarditis/pericarditis and associated adverse cardiovascular events in patients with COVID-19.
A retrospective cohort study was conducted using electronic medical records from a global federated health research network. Patients were included based on a diagnosis of COVID-19 and new-onset myocarditis or pericarditis. Patients with COVID-19 and myocarditis/pericarditis were 1:1 propensity score matched for age, sex, race and comorbidities to patients with COVID-19 but without myocarditis/pericarditis. The outcomes of interest were 6-month all-cause mortality, hospitalisation, cardiac arrest, incident heart failure, incident atrial fibrillation and acute myocardial infarction, comparing patients with and without myocarditis/pericarditis. Of 718,365 patients with COVID-19, 35,820 (5.0%) developed new-onset myocarditis and 10,706 (1.5%) developed new-onset pericarditis. Six-month all-cause mortality was 3.9% (n = 702) in patients with myocarditis and 2.9% (n = 523) in matched controls (p < .0001), odds ratio 1.36 (95% confidence interval (CI): 1.21-1.53). Six-month all-cause mortality was 15.5% (n = 816) for pericarditis and 6.7% (n = 356) in matched controls (p < .0001), odds ratio 2.55 (95% CI: 2.24-2.91). Receiving critical care was associated with significantly higher odds of mortality for patients with myocarditis and pericarditis. Patients with pericarditis seemed to associate with more new-onset cardiovascular sequelae than those with myocarditis. This finding was consistent when looking at pre-COVID-19 data with pneumonia patients.
Patients with COVID-19 who present with myocarditis/pericarditis associate with increased odds of major adverse events and new-onset cardiovascular sequelae.
COVID-19 有广泛的心血管后遗症，包括心肌炎和心包炎；然而，其患病率和临床影响尚不清楚。我们研究了 COVID-19 患者中新发心肌炎/心包炎的患病率以及相关不良心血管事件。
本研究是一项使用全球联邦健康研究网络的电子病历进行的回顾性队列研究。基于 COVID-19 诊断和新发心肌炎或心包炎纳入患者。COVID-19 伴心肌炎/心包炎患者与 COVID-19 但无心肌炎/心包炎患者按年龄、性别、种族和合并症进行 1:1 倾向评分匹配。主要终点为 6 个月全因死亡率、住院、心脏骤停、新发心力衰竭、新发心房颤动和急性心肌梗死，比较心肌炎/心包炎患者和无心肌炎/心包炎患者。在 718365 例 COVID-19 患者中，35820 例（5.0%）新发心肌炎，10706 例（1.5%）新发心包炎。心肌炎患者 6 个月全因死亡率为 3.9%（n=702），匹配对照患者为 2.9%（n=523）（p<0.0001），比值比 1.36（95%置信区间[CI]：1.21-1.53）。心包炎患者 6 个月全因死亡率为 15.5%（n=816），匹配对照患者为 6.7%（n=356）（p<0.0001），比值比 2.55（95%CI：2.24-2.91）。接受重症监护与心肌炎和心包炎患者死亡率显著升高相关。心包炎患者似乎比心肌炎患者更易出现新发心血管后遗症。当查看 COVID-19 前数据与肺炎患者时，发现了这一结果。
新发心肌炎/心包炎的 COVID-19 患者与发生重大不良事件和新发心血管后遗症的风险增加相关。
