Cheng Lu, Li Yan-Hong, Wu Yin-Lan, Luo Yu-Bin, Zhou Yu, Ye Tong, Liang Xiu-Ping, Wu Tong, Huang De-Ying, Zhao Jing, Liu Yi, Liang Zong-An, Tan Chun-Yu
Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China.
Department of Rheumatology and Immunology, Laboratory of Rheumatology and Immunology West China Hospital, Sichuan University, Chengdu, China.
Microbiol Spectr. 2025 Jun 3;13(6):e0013425. doi: 10.1128/spectrum.00134-25. Epub 2025 May 15.
The 2019 coronavirus disease (COVID-19) pandemic has changed the characteristics of many diseases. It remains unclear whether idiopathic inflammatory myopathies (IIMs) exhibit distinct phenotypes in the context of COVID-19. This retrospective study analyzed patients with IIMs admitted to West China Hospital from January 2022 to December 2023. Among them, 171 had a history of COVID-19 (prior COVID-19 [PC]), while 121 did not (no prior COVID-19 [NPC]). Medical histories, lab tests, and echocardiography data were compared. The PC group exhibited a greater incidence of cardiac damage, including a greater proportion of cardiac injury ( = 0.016), clinical diagnosis of myocarditis ( = 0.02), palpitation ( = 0.031), and Myositis Activity Assessment Visual Analog Scale/Myositis Intention-to-Treat Activity Index cardiovascular involvement scores (all < 0.001), and elevated levels of myoglobin ( = 0.03), creatinine kinase MB ( = 0.015), cardiac troponin T ( 0.011), N-terminal pro-B-type natriuretic peptide ( = 0.028), lactate dehydrogenase ( = 0.033), and hydroxybutyrate dehydrogenase ( = 0.019). Echocardiographic analysis revealed a greater diameter of the left atrium ( = 0.040), left ventricle ( 0.013), greater end-diastolic dimension ( = 0.042), and greater end-diastolic volume ( = 0.036) in the PC group than in the NPC group. Transcriptional data analysis based on public databases indicated that various mechanisms, including collagen matrix proliferation, calcium ion pathway regulation, oxidative stress, cell proliferation, and inflammatory molecules, collectively contribute to the pathogenesis of myocardial damage in patients with IIMs and COVID-19. The study serves as a crucial reminder for clinicians to remain vigilant regarding the enduring cardiovascular consequences associated with IIMs after COVID-19.
This study systematically analyzed the clinical features, laboratory test results, and echocardiographic findings of patients with IIMs, comparing those with and without a history of COVID-19 infection. The analysis revealed significant alterations in the clinical manifestations of IIM patients after COVID-19, particularly in relation to cardiac involvement. Our findings highlight the crucial importance for clinicians to maintain vigilance concerning the potential long-term cardiovascular sequelae associated with IIMs in post-COVID-19 patients.
2019冠状病毒病（COVID-19）大流行改变了许多疾病的特征。目前尚不清楚特发性炎性肌病（IIM）在COVID-19背景下是否表现出独特的表型。这项回顾性研究分析了2022年1月至2023年12月入住华西医院的IIM患者。其中，171例有COVID-19病史（既往COVID-19 [PC]），而121例没有（无既往COVID-19 [NPC]）。比较了病史、实验室检查和超声心动图数据。PC组心脏损害的发生率更高，包括心脏损伤的比例更高（P = 0.016）、心肌炎的临床诊断（P = 0.02）、心悸（P = 0.031）以及肌炎活动评估视觉模拟量表/肌炎意向性治疗活动指数心血管受累评分（均P < 0.001），并且肌红蛋白水平升高（P = 0.03）、肌酸激酶MB升高（P = 0.015）、心肌肌钙蛋白T升高（P = 0.011）、N末端B型利钠肽原升高（P = 0.028）、乳酸脱氢酶升高（P = 0.033）和羟丁酸脱氢酶升高（P = 0.019）。超声心动图分析显示，PC组的左心房直径更大（P = 0.040）、左心室更大（P = 0.013）、舒张末期内径更大（P = 0.042）以及舒张末期容积更大（P = 0.036），均高于NPC组。基于公共数据库的转录数据分析表明，包括胶原基质增殖、钙离子途径调节、氧化应激、细胞增殖和炎症分子在内的多种机制共同促成了IIM合并COVID-19患者心肌损伤的发病机制。该研究强烈提醒临床医生要对COVID-19后IIM相关的持久心血管后果保持警惕。
本研究系统分析了IIM患者的临床特征、实验室检查结果和超声心动图表现，比较了有和没有COVID-19感染史的患者。分析显示COVID-19后IIM患者的临床表现有显著改变，特别是在心脏受累方面。我们的研究结果强调了临床医生对COVID-19后患者中与IIM相关的潜在长期心血管后遗症保持警惕的至关重要性。
