Radiology Medical Affairs, Bayer AG, Berlin, Germany
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University, London, UK.
Open Heart. 2024 Nov 9;11(2):e002947. doi: 10.1136/openhrt-2024-002947.
Previous research has suggested a heightened risk of acute myocarditis after COVID-19 infection. However, it is not clear from existing work whether this risk is higher than would be expected after comparable viral respiratory infections. This information is important to guide risk assessments and clinical practice.
A retrospective cohort study of US administrative health claims was conducted to compare the rates of myocarditis after COVID-19 with that after influenza infection and describe the clinical use of diagnostic assessments.Patients with either incident COVID-19 diagnosis (between 1 January 2020 and 31 December 2021) or incident influenza diagnosis (between 1 January 2016 and 31 December 2018), with at least 12 months of continuous enrolment prior to index date and without a previous diagnosis of myocarditis were included.The primary outcome was clinically diagnosed acute myocarditis recorded after COVID-19 or influenza infection. Results are reported as covariate-adjusted subdistribution HRs from competing risk regression with COVID-19 considered as the exposure of interest and influenza as the reference group. Death was considered a competing risk.
1 120 760 adult COVID-19 patients and 439 278 adult influenza patients were identified, of which 669 (0.06%) adult COVID-19 patients and 91 (0.02%) adult influenza patients received a diagnosis of myocarditis. The myocarditis rate per 1000 person-years was 0.73 (95% CI 0.67 to 0.78) for adult COVID-19 patients and 0.24 (95% CI 0.19 to 0.28) for adult influenza populations. In models comprehensively adjusted for demographic and clinical risk factors, COVID-19 diagnosis (compared with influenza diagnosis), cardiac comorbidities, being male and under the age of 30 were independently associated with an increased risk of myocarditis in the year after diagnosis.
These findings support a distinct link between COVID-19 and myocarditis, which appears greater than after a similar viral respiratory infection. As such, a greater degree of clinical suspicion and investigation according to existing diagnostic pathways is recommended.
先前的研究表明，COVID-19 感染后急性心肌炎的风险增加。然而，现有研究尚不清楚这种风险是否高于类似的病毒性呼吸道感染后预期的风险。这些信息对于指导风险评估和临床实践很重要。
本研究采用美国行政健康保险索赔的回顾性队列研究，比较 COVID-19 后心肌炎的发生率与流感感染后的发生率，并描述诊断评估的临床应用。纳入研究的患者要么首次确诊 COVID-19（2020 年 1 月 1 日至 2021 年 12 月 31 日期间），要么首次确诊流感（2016 年 1 月 1 日至 2018 年 12 月 31 日期间），且在指数日期前至少有 12 个月的连续参保，且无先前心肌炎诊断。主要结局是 COVID-19 或流感感染后临床诊断的急性心肌炎。结果以竞争风险回归的校正亚分布 HR 表示，以 COVID-19 作为感兴趣的暴露因素，以流感作为参考组。死亡被视为竞争风险。
本研究共纳入 1120760 名成年 COVID-19 患者和 439278 名成年流感患者，其中 669（0.06%）名成年 COVID-19 患者和 91（0.02%）名成年流感患者被诊断为心肌炎。每 1000 人年的心肌炎发生率为 COVID-19 患者 0.73（95%CI 0.67 至 0.78），流感患者 0.24（95%CI 0.19 至 0.28）。在综合调整了人口统计学和临床危险因素的模型中，与流感诊断相比，COVID-19 诊断、心脏合并症、男性和 30 岁以下年龄与诊断后一年内心肌炎风险增加独立相关。
这些发现支持 COVID-19 与心肌炎之间存在明确关联，且这种关联似乎大于类似的病毒性呼吸道感染。因此，建议根据现有的诊断途径，提高对心肌炎的临床怀疑和调查程度。
