Liu Huihui, Zhou Ping, Huang Yan, Yan Sulan, Zhou Lei, Gao Chuanyu, Wang Lian, Tang Jianjun, Zhou Qiong, Li Xinqing, Zhuang Xiaofeng, Zhai Mei, Huang Liyan, Zhao Xuemei, Greenberg Barry, Hsi David H, Zhang Yuhui, Zhang Jian
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, The People's Hospital of Hunan Province, Changsha, China.
ESC Heart Fail. 2025 Feb;12(1):338-352. doi: 10.1002/ehf2.15048. Epub 2024 Sep 19.
Acute myocarditis (AM) has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) infection. This study was conducted to present the clinical characteristics, disease courses and short-term prognoses of Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induced AM in China, which has been unavailable so far.
Data from 28 patients diagnosed with definite COVID-19-associated AM from 6 hospitals in China between 1 December 2022 and 30 June 2023 were collected and analysed. The diagnosis of AM was based on increased troponin level plus typical findings of AM on cardiac magnetic resonance (CMR) imaging and/or endomyocardial biopsy. Among 28 patients with definite COVID-19-related AM, median age was 37 years (Q1-Q3: 22-52) and 53.6% were men. Twenty-three patients occurred within 2 weeks of the onset of COVID-19 infection, 10 patients underwent endomyocardial biopsy and CMR was performed in all patients. Seven (25.0%) patients developed fulminant myocarditis that required inotropic agents or temporary mechanical circulatory support. Of the nine patients (32.1%) with left ventricular ejection fraction (LVEF) below 50% on admission, five had fully recovered LVEF and two demonstrated improvement but to levels below normal at discharge. The comparison of CMR parameters between the baseline and first follow-up showed that ECV was decreased at the first follow-up [28.95 (25.38, 32.55)% vs. 33.65 (31.58, 37.55)%, P = 0.028), while other CMR parameters had no significant changes. Eighteen patients (64.3%) were prescribed with corticosteroids, and seven patients (25.0%) underwent temporary mechanical circulatory support. Only two patients died during hospitalization.
The majority of COVID-19-associated AM occurred within 2 weeks of Omicron variant infection. Fulminant myocarditis complicated by hemodynamic instability requiring temporary mechanical circulatory support was not uncommon. However, short-term outcome was generally good and most AM patients fully recovered.
急性心肌炎（AM）已被公认为是2019冠状病毒病（COVID-19）感染的一种罕见并发症。本研究旨在呈现中国严重急性呼吸综合征冠状病毒2（SARS-CoV-2）奥密克戎变异株所致急性心肌炎的临床特征、病程及短期预后，目前尚无相关报道。
收集并分析了2022年12月1日至2023年6月30日期间中国6家医院确诊的28例确诊COVID-19相关急性心肌炎患者的数据。急性心肌炎的诊断基于肌钙蛋白水平升高以及心脏磁共振成像（CMR）和/或心内膜心肌活检的典型急性心肌炎表现。在28例确诊的COVID-19相关急性心肌炎患者中，中位年龄为37岁（四分位间距：22 - 52岁），男性占53.6%。23例患者在COVID-19感染发病后2周内发病，10例患者接受了心内膜心肌活检，所有患者均进行了心脏磁共振成像检查。7例（25.0%）患者发展为暴发性心肌炎，需要使用正性肌力药物或临时机械循环支持。入院时左心室射血分数（LVEF）低于50%的9例患者（32.1%）中，5例患者的LVEF已完全恢复，2例患者有所改善，但出院时仍低于正常水平。基线与首次随访时CMR参数的比较显示，首次随访时细胞外容积分数（ECV）降低[28.95（25.38，32.55）%对33.65（31.58，37.55）%，P = 0.028]，而其他CMR参数无显著变化。18例患者（64.3%）接受了糖皮质激素治疗，7例患者（25.0%）接受了临时机械循环支持。住院期间仅有2例患者死亡。
大多数COVID-19相关急性心肌炎发生在奥密克戎变异株感染后2周内。暴发性心肌炎合并血流动力学不稳定需要临时机械循环支持的情况并不少见。然而，短期预后总体良好，大多数急性心肌炎患者完全康复。
