Shu Hongyang, Zhao Chunxia, Wang Dao Wen
Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China.
Cardiol Plus. 2023 Apr-Jun;8(2):72-81. doi: 10.1097/CP9.0000000000000046. Epub 2023 Apr 14.
Coronavirus disease 2019 (COVID-19) disease has infected nearly 600 million people, resulting in > 6 million deaths, with many of them dying from cardiovascular diseases. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is caused by a combination of the virus surface spike protein and the human angiotensin-converting enzyme 2 (ACE2) receptor. In addition to being highly expressed in the lungs, ACE2 is widely distributed in the heart, mainly in myocardial cells and pericytes. Like other types of viruses, SARS-CoV-2 can cause myocarditis after infecting the myocardial tissue, which is attributed to the direct damage of the virus and uncontrolled inflammatory reactions. Patients with chest tightness, palpitation, abnormal electrocardiogram, and cardiac troponin elevation, should be suspected of myocarditis within 1-3 weeks of COVID-19 infection. When the hemodynamics change rapidly, fulminant myocarditis should be suspected. Cardiac ultrasound, myocardial biopsy, cytokine detection, cardiac magnetic resonance imaging, 18F-fluorodeoxyglucose positron emission tomography, and other examination methods can assist in the diagnosis. Although scientists and clinicians have made concerted efforts to seek treatment and prevention measures, there are no clear recommendations for the treatment of COVID-19-related myocarditis. For most cases of common myocarditis, general symptomatic and supportive treatments are used. For COVID-19-related fulminant myocarditis, it is emphasized to achieve "early identification, early diagnosis, early prediction, and early treatment" based on the "life support-based comprehensive treatment regimen." Mechanical circulatory support therapy can rest the heart, which is a cure for symptoms, and immune regulation therapy can control the inflammatory storms which is a cure for the disease. Furthermore, complications of COVID-19-related myocarditis, such as arrhythmia, thrombosis, and infection, should be actively treated. Herein, we summarized the incidence rate, manifestations, and diagnosis of COVID-19-related myocarditis and discussed in detail the treatment of COVID-19-related myocarditis, especially the treatment strategy of fulminant myocarditis.
2019冠状病毒病（COVID-19）已感染近6亿人，导致超过600万人死亡，其中许多人死于心血管疾病。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染是由病毒表面刺突蛋白与人类血管紧张素转换酶2（ACE2）受体共同作用引起的。ACE2除了在肺中高表达外，还广泛分布于心脏，主要存在于心肌细胞和周细胞中。与其他类型的病毒一样，SARS-CoV-2感染心肌组织后可引起心肌炎，这归因于病毒的直接损伤和不受控制的炎症反应。出现胸闷、心悸、心电图异常及心肌肌钙蛋白升高的患者，在COVID-19感染1至3周内应怀疑患有心肌炎。当血流动力学迅速变化时，应怀疑暴发性心肌炎。心脏超声、心肌活检、细胞因子检测、心脏磁共振成像、18F-氟脱氧葡萄糖正电子发射断层扫描等检查方法可协助诊断。尽管科学家和临床医生共同努力寻找治疗和预防措施，但对于COVID-19相关心肌炎的治疗尚无明确建议。对于大多数常见心肌炎病例，采用一般的对症和支持治疗。对于COVID-19相关暴发性心肌炎，强调在“基于生命支持的综合治疗方案”基础上实现“早识别、早诊断、早预测、早治疗”。机械循环支持治疗可使心脏得到休息，这是对症治疗，免疫调节治疗可控制炎症风暴，这是对因治疗。此外，应积极治疗COVID-19相关心肌炎的并发症，如心律失常、血栓形成和感染。在此，我们总结了COVID-19相关心肌炎的发病率、表现和诊断，并详细讨论了COVID-19相关心肌炎的治疗，尤其是暴发性心肌炎的治疗策略。
