Abumayyaleh Mohammad, Schupp Tobias, Behnes Michael, El-Battrawy Ibrahim, Hamdani Nazha, Akin Ibrahim
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, 68167 Mannheim, Germany.
Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany.
J Clin Med. 2025 Jun 27;14(13):4560. doi: 10.3390/jcm14134560.
COVID-19, caused by SARS-CoV-2, has been associated with a range of cardiovascular complications, including myocarditis. This review aims to systematically present the clinical manifestations, underlying pathophysiological mechanisms, diagnostic approaches, and management strategies for both COVID-19-associated myocarditis and myocarditis related to SARS-CoV-2 vaccination. We conducted a literature search using the PubMed database, covering studies published up to early 2024. Search terms included combinations of "COVID-19", "Coronavirus", "SARS-CoV-2", and/or "vaccination" with "cardiac injury", "cardiac inflammation", "myocarditis". The reported prevalence of COVID-19-associated myocarditis varies between 2.3% and 5.0%, though myocardial injury is more frequently observed than confirmed myocarditis. Pathophysiological mechanisms include direct viral damage, immune-mediated injury, and molecular mimicry. Clinically, patients may present with chest pain, dyspnea, and fever. Diagnostic workup includes electrocardiography (ECG), troponin measurement, echocardiography, cardiac magnetic resonance imaging (cMRI), and in selected cases, endomyocardial biopsy (EMB). The management and disposition of COVID-19-associated myocarditis varies according to severity, especially to allow targeted treatment of complications. Glucocorticoids are a mainstay of treatment in severe cases. Myocarditis following SARS-CoV-2 vaccination is rare, more frequently reported in males under 30 years, and is generally associated with a favorable prognosis. Despite this, the benefits of vaccination continue to outweigh the risks. COVID-19 is associated with an increased risk of heart failure and other cardiovascular complications, underlining the importance of long-term follow-up and preventive strategies. Further research is needed to better understand the pathogenesis and optimal management of myocarditis in the context of COVID-19, with the goal of developing evidence-based therapeutic algorithms.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）与一系列心血管并发症有关，包括心肌炎。本综述旨在系统介绍COVID-19相关心肌炎以及与SARS-CoV-2疫苗接种相关的心肌炎的临床表现、潜在病理生理机制、诊断方法和管理策略。我们使用PubMed数据库进行了文献检索，涵盖截至2024年初发表的研究。检索词包括“COVID-19”“冠状病毒”“SARS-CoV-2”和/或“疫苗接种”与“心脏损伤”“心脏炎症”“心肌炎”的组合。报告的COVID-19相关心肌炎患病率在2.3%至5.0%之间，不过心肌损伤比确诊的心肌炎更常见。病理生理机制包括病毒直接损伤、免疫介导损伤和分子模拟。临床上，患者可能出现胸痛、呼吸困难和发热。诊断检查包括心电图（ECG）、肌钙蛋白检测、超声心动图、心脏磁共振成像（cMRI），在某些情况下还包括心内膜心肌活检（EMB）。COVID-19相关心肌炎的管理和处置根据严重程度而异，特别是要对并发症进行针对性治疗。糖皮质激素是重症病例治疗的主要药物。SARS-CoV-2疫苗接种后发生的心肌炎很少见，在30岁以下男性中报告较多，且一般预后良好。尽管如此，疫苗接种的益处仍然大于风险。COVID-19与心力衰竭和其他心血管并发症风险增加有关，凸显了长期随访和预防策略的重要性。需要进一步研究以更好地了解COVID-19背景下心肌炎的发病机制和最佳管理方法，目标是制定基于证据的数据处理算法。
