Clinical characteristics of non-ischaemic myocardial injury in covid-19
| Study | Region | Age | Sex | Comorbidities | Symptoms/Signs | ECG | Other diagnostic studies | Biomarkers | Dx | Treatment | Outcome |
| Zeng et al 87 | China | 63 | M | Allergic cough | Fever, cough, dyspnoea | Sinus tachycardia | TTE: diffuse dyskinesia, LVEF: 32%, PAP: 44 mm Hg, RV normal | TnI, IL-6, BNP elevated | Myocarditis? | Antiviral, CRRT, corticosteroid, immunoglobulin, high-flow oxygen | Recovered, LVEF 68% |
| Inciardi et al 35 | Italy | 53 | F | None | Fever, dry cough, fatigue, hypotensive, normal oxygen saturation | Low voltage, diffuse ST-elevation, ST depression in V1 and aVR | CXR: normal; CMR: LVH, BiV hypokinesis LVEF: 35%, BiV myocardial oedema, diffuse LGE | hs-TnT, NT-proBNP, elevated | Myopericarditis | Antiviral, corticosteroid, CQ, dobutamine, medical treatment for HF | Improved, LVEF 44% on day 6 |
| Fried et al 32 | USA | 64 | F | HTN, hyperlipidaemia | Chest pressure, afebrile, no respiratory symptoms, normal oxygen saturation | Sinus tachycardia, low QRS voltage, diffuse ST and PR elevations, ST depression in aVR | CXR: normal Cath: non-obstructive RHC: RA: 10 mm Hg, PCWP 21 mm Hg, CI: 1 L/min/m2. TTE: LVH, LVEF 30%, severe hypokinetic RV. | TnI elevated | Myopericarditis, with cardiogenic shock | IABP, dobutamine, HCQ | Recovered, LVEF 50% on day 10 |
| Fried et al 32 | USA | 38 | M | DM | Cough, chest pain, dyspnoea, rapidly deteriorated respiratory status | SVT, Sinus tachycardia, AIVR | CXR: bilateral pulmonary opacities TTE normal (before VV ECMO), TTE: LVEF 20%–25%, akinesis of mid-LV segments; mildly reduced RV function | TnT, IL-6, ferritin, CRP elevated | Stress cardiomyopathy | HCQ, invasive ventilation and VV ECMO, after LV function deterioration, change to VAV ECMO | Decannulated from ECMO after 7 days, stable, remain on mechanical ventilation |
| Fried et al 32 | USA | 64 | F | NICM with normal LVEF, AF, HTN, DM | Non-productive cough, afebrile, dyspnoea, oxygen saturation 88% | Sinus, PVC, PAC, lateral T inversion, QTc 528 ms | CXR: bibasilar opacities, vascular congestion TTE: severely reduced LV function | TnT, NT-proBNP, ferritin elevated | Decompensated heart failure | Broad-spectrum antibiotics, nitroglycerin, furosemide, mechanical ventilation, vasopressor | Remain intubated on day 9 |
| Fried et al 32 | USA | 51 | M | Heart and renal transplant | Fever, dry cough, dyspnoea | New T-wave inversion | TTE: normal cardiac allograft function | hs-TnT, IL-6, NT-proBNP, ferritin elevated | Myocarditis? | MMF discontinued, HCQ, azithromycin, ceftriaxone | Discharged |
| Sala et al 33 | Italy | 43 | F | None | Chest pain, dyspnoea, oxygen saturation 89% | Sinus, new non-specific T-wave changes | CXR: multifocal bilateral opacities; Coronary CTA normal; 3D CT: mid-basal LV hypokinesia, normal apical function TTE: LVEF 43%, inferior wall hypokinesis; CMR on D7: LVEF 64%, mild hypokinesia at mid and basal LV, diffuse myocardial oedema, no LGE; EMB: lymphocytic infiltration, interstitial oedema, limited foci of necrosis, no SARS-CoV-2 genome within myocardium | hs-TnT, NT-proBNP elevated | Myocarditis | CPAP, antiviral, HCQ | Discharged |
AF, atrial fibrillation; AIVR, accelerated idioventricular rhythm; BiV, biventricular; BNP, brain natriuretic peptide; CI, cardiac index; CMR, cardiovascular magnetic resonance; CPAP, continuous positive airway pressure; CQ, chloroquine; CRP, C reactive protein; CRRT, continuous renal replacement therapy; CTA, computed tomography angiogram; CXR, chest X-ray; DM, diabetes mellitus; Dx, diagnosis; ECMO, extracorporeal membrane oxygenation; EMB, endomyocardial biopsy; HCQ, hydrochloroquine; HF, heart failure; HTN, hypertension; IABP, intra-aortic balloon pump; LGE, late gadolinium enhancement; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; MMF, mycophenolate mofetil; NICM, non-ischaemic cardiomyopathy; NT-proBNP, N-terminal probrain natriuretic peptide; PAC, premature atrial complex; PAP, pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; PVC, premature ventricular complex; RHC, right heart catherisation; RV, right ventricle; SVT, supraventricular tachycardia; Tn, troponin; TTE, transthoracic echocardiogram; VAV, veno-arterial-venous; VV, veno-venous.