Bouchaala Abderrahmane, Kerrouani Oualid, Yassini Yassine, Tadili Sidi Jawad, Tachinante Rajae, Oukerraj Latifa, Cherti Mohamed, Alilou Mustapha
Department of Emergencies, University Hospital of Rabat, Morocco.
Department of Cardiology B, University Hospital of Rabat, Morocco.
IHJ Cardiovasc Case Rep. 2023 Apr-Jun;7(2):53-57. doi: 10.1016/j.ihjccr.2023.05.004. Epub 2023 May 30.
BACKGROUND: Coronavirus disease 2019 COVID-19 still remains a major cause of morbidity and mortality worldwide, mainly due to Acute Respiratory Distress Syndrome (ARDS). Nevertheless, other extra-pulmonary pathological aspects of COVID-19, notably cardiovascular, were disclosed as the global understanding of the pathogen agent advanced. OBJECTIVES: To detect and evaluate acute myocarditis in patients with active and symptomatic COVID-19 infection. MATERIALS AND METHODS: In this prospective analysis, patients presented with active COVID-19 illness and meeting the inclusion criteria were identified at the University Hospital Complex of Rabat between January and September 2021. RESULTS: Fifteen patients (8 males and 7 females) aged from 17 to 52 were included during the analysis period, the average delay between the confirmation of COVID-19 and the onset of myocarditis symptomatology was 17 days. The symptomatology was dominated by chest pain, unexplained cardiogenic shock and palpitations. The ECG showed essentially diffuse repolarization disorders. The inflammatory markers were significantly disturbed with an elevation of ultra-sensitive cardiac troponin I in all patients. Cardiac MRI showed impaired global longitudinal strain (GLS) myocardial edema, early and late subepicardial Gadolinium enhancement, compared to the control group (p < 0,01). CONCLUSION: Cardiac involvement was detected in a proportion of patients with active COVID-19. Age, gender, clinical and electrical presentations didn't seem to influence the diagnosis. Cardiac MRI played an essential role for detecting and evaluating active myocarditis. Patients who presented myocardial injury had to have a longer follow-up as current understanding of long-term prognosis is still lacking.
背景:2019年冠状病毒病(COVID-19)仍是全球发病和死亡的主要原因,主要是由于急性呼吸窘迫综合征(ARDS)。然而,随着对病原体的全球认识不断深入,COVID-19的其他肺外病理方面,尤其是心血管方面也被揭示出来。 目的:检测和评估活动性和有症状的COVID-19感染患者的急性心肌炎。 材料与方法:在这项前瞻性分析中,2021年1月至9月期间在拉巴特大学医院综合院区确定了患有活动性COVID-19疾病且符合纳入标准的患者。 结果:分析期间纳入了15名年龄在17至52岁之间的患者(8名男性和7名女性),COVID-19确诊至心肌炎症状出现的平均间隔时间为17天。症状以胸痛、不明原因的心源性休克和心悸为主。心电图主要显示弥漫性复极异常。炎症标志物明显紊乱,所有患者的超敏心肌肌钙蛋白I均升高。与对照组相比,心脏磁共振成像显示整体纵向应变(GLS)受损、心肌水肿、心外膜下早期和晚期钆增强(p < 0.01)。 结论:在一部分活动性COVID-19患者中检测到心脏受累。年龄、性别、临床和电生理表现似乎不影响诊断。心脏磁共振成像在检测和评估活动性心肌炎方面发挥了重要作用。由于目前对长期预后仍缺乏了解,出现心肌损伤的患者必须进行更长时间的随访。
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