Phenotypic Heterogeneity of Fulminant COVID-19--Related Myocarditis in Adults
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Adults who have been infected with SARS-CoV-2 can develop a multisystem inflammatory syndrome (MIS-A), including fulminant myocarditis. Yet, several patients fail to meet MIS-A criteria, suggesting the existence of distinct phenotypes in fulminant COVID-19-related myocarditis.
OBJECTIVES: This study sought to compare the characteristics and clinical outcome between patients with fulminant COVID-19-related myocarditis fulfilling MIS-A criteria (MIS-A+) or not (MIS-A-).
METHODS: A monocentric retrospective analysis of consecutive fulminant COVID-19-related myocarditis in a 26-bed intensive care unit (ICU).
RESULTS: Between March 2020 and June 2021, 38 patients required ICU admission (male 66%; mean age 32 ± 15 years) for suspected fulminant COVID-19-related myocarditis. In-ICU treatment for organ failure included dobutamine 79%, norepinephrine 60%, mechanical ventilation 50%, venoarterial extracorporeal membrane oxygenation 42%, and renal replacement therapy 29%. In-hospital mortality was 13%. Twenty-five patients (66%) met the MIS-A criteria. MIS-A- patients compared with MIS-A+ patients were characterized by a shorter delay between COVID-19 symptoms onset and myocarditis, a lower left ventricular ejection fraction, and a higher rate of in-ICU organ failure, and were more likely to require mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (92% vs 16%; P < 0.0001). In-hospital mortality was higher in MIS-A- patients (31% vs 4%). MIS-A+ had higher circulating levels of interleukin (IL)-22, IL-17, and tumor necrosis factor-α (TNF-α), whereas MIS-A- had higher interferon-α2 (IFN-α2) and IL-8 levels. RNA polymerase III autoantibodies were present in 7 of 13 MIS-A- patients (54%) but in none of the MIS-A+ patients.
CONCLUSION: MIS-A+ and MIS-A- fulminant COVID-19-related myocarditis patients have 2 distinct phenotypes with different clinical presentations, prognosis, and immunological profiles. Differentiating these 2 phenotypes is relevant for patients' management and further understanding of their pathophysiology.
| Errataetall: |
CommentIn: J Am Coll Cardiol. 2022 Jul 26;80(4):313-315. - PMID 35863847 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:80 |
|---|---|
| Enthalten in: |
Journal of the American College of Cardiology - 80(2022), 4 vom: 26. Juli, Seite 299-312 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Barhoum, Petra [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 25.07.2022 Date Revised 07.06.2023 published: Print CommentIn: J Am Coll Cardiol. 2022 Jul 26;80(4):313-315. - PMID 35863847 Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jacc.2022.04.056 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM343838427 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM343838427 | ||
| 003 | DE-627 | ||
| 005 | 20231226021401.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jacc.2022.04.056 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1146.xml |
| 035 | |a (DE-627)NLM343838427 | ||
| 035 | |a (NLM)35863846 | ||
| 035 | |a (PII)S0735-1097(22)05104-X | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Barhoum, Petra |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Phenotypic Heterogeneity of Fulminant COVID-19--Related Myocarditis in Adults |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 25.07.2022 | ||
| 500 | |a Date Revised 07.06.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: J Am Coll Cardiol. 2022 Jul 26;80(4):313-315. - PMID 35863847 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Adults who have been infected with SARS-CoV-2 can develop a multisystem inflammatory syndrome (MIS-A), including fulminant myocarditis. Yet, several patients fail to meet MIS-A criteria, suggesting the existence of distinct phenotypes in fulminant COVID-19-related myocarditis | ||
| 520 | |a OBJECTIVES: This study sought to compare the characteristics and clinical outcome between patients with fulminant COVID-19-related myocarditis fulfilling MIS-A criteria (MIS-A+) or not (MIS-A-) | ||
| 520 | |a METHODS: A monocentric retrospective analysis of consecutive fulminant COVID-19-related myocarditis in a 26-bed intensive care unit (ICU) | ||
| 520 | |a RESULTS: Between March 2020 and June 2021, 38 patients required ICU admission (male 66%; mean age 32 ± 15 years) for suspected fulminant COVID-19-related myocarditis. In-ICU treatment for organ failure included dobutamine 79%, norepinephrine 60%, mechanical ventilation 50%, venoarterial extracorporeal membrane oxygenation 42%, and renal replacement therapy 29%. In-hospital mortality was 13%. Twenty-five patients (66%) met the MIS-A criteria. MIS-A- patients compared with MIS-A+ patients were characterized by a shorter delay between COVID-19 symptoms onset and myocarditis, a lower left ventricular ejection fraction, and a higher rate of in-ICU organ failure, and were more likely to require mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (92% vs 16%; P < 0.0001). In-hospital mortality was higher in MIS-A- patients (31% vs 4%). MIS-A+ had higher circulating levels of interleukin (IL)-22, IL-17, and tumor necrosis factor-α (TNF-α), whereas MIS-A- had higher interferon-α2 (IFN-α2) and IL-8 levels. RNA polymerase III autoantibodies were present in 7 of 13 MIS-A- patients (54%) but in none of the MIS-A+ patients | ||
| 520 | |a CONCLUSION: MIS-A+ and MIS-A- fulminant COVID-19-related myocarditis patients have 2 distinct phenotypes with different clinical presentations, prognosis, and immunological profiles. Differentiating these 2 phenotypes is relevant for patients' management and further understanding of their pathophysiology | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a RNA polymerase III autoantibodies | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a VA-ECMO | |
| 650 | 4 | |a cytokines | |
| 650 | 4 | |a fulminant myocarditis | |
| 650 | 4 | |a multisystem inflammatory syndrome | |
| 650 | 7 | |a Autoantibodies |2 NLM | |
| 650 | 7 | |a anti-RNA-polymerase III autoantibody |2 NLM | |
| 700 | 1 | |a Pineton de Chambrun, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Dorgham, Karim |e verfasserin |4 aut | |
| 700 | 1 | |a Kerneis, Mathieu |e verfasserin |4 aut | |
| 700 | 1 | |a Burrel, Sonia |e verfasserin |4 aut | |
| 700 | 1 | |a Quentric, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Parizot, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Chommeloux, Juliette |e verfasserin |4 aut | |
| 700 | 1 | |a Bréchot, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Moyon, Quentin |e verfasserin |4 aut | |
| 700 | 1 | |a Lebreton, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Boussouar, Samia |e verfasserin |4 aut | |
| 700 | 1 | |a Schmidt, Matthieu |e verfasserin |4 aut | |
| 700 | 1 | |a Yssel, Hans |e verfasserin |4 aut | |
| 700 | 1 | |a Lefevre, Lucie |e verfasserin |4 aut | |
| 700 | 1 | |a Miyara, Makoto |e verfasserin |4 aut | |
| 700 | 1 | |a Charuel, Jean-Luc |e verfasserin |4 aut | |
| 700 | 1 | |a Marot, Stéphane |e verfasserin |4 aut | |
| 700 | 1 | |a Marcelin, Anne-Geneviève |e verfasserin |4 aut | |
| 700 | 1 | |a Luyt, Charles-Edouard |e verfasserin |4 aut | |
| 700 | 1 | |a Leprince, Pascal |e verfasserin |4 aut | |
| 700 | 1 | |a Amoura, Zahir |e verfasserin |4 aut | |
| 700 | 1 | |a Montalescot, Gilles |e verfasserin |4 aut | |
| 700 | 1 | |a Redheuil, Alban |e verfasserin |4 aut | |
| 700 | 1 | |a Combes, Alain |e verfasserin |4 aut | |
| 700 | 1 | |a Gorochov, Guy |e verfasserin |4 aut | |
| 700 | 1 | |a Hékimian, Guillaume |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of the American College of Cardiology |d 1987 |g 80(2022), 4 vom: 26. Juli, Seite 299-312 |w (DE-627)NLM012608602 |x 1558-3597 |7 nnns |
| 773 | 1 | 8 | |g volume:80 |g year:2022 |g number:4 |g day:26 |g month:07 |g pages:299-312 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jacc.2022.04.056 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 80 |j 2022 |e 4 |b 26 |c 07 |h 299-312 | ||