Table 5

Clinical characteristics of non-ischaemic myocardial injury in covid-19

StudyRegionAgeSexComorbiditiesSymptoms/SignsECGOther diagnostic studiesBiomarkersDxTreatmentOutcome
Zeng et al 87 China63MAllergic coughFever, cough, dyspnoeaSinus tachycardiaTTE: diffuse dyskinesia, LVEF: 32%, PAP: 44 mm Hg, RV normalTnI, IL-6, BNP elevatedMyocarditis?Antiviral, CRRT, corticosteroid, immunoglobulin, high-flow oxygenRecovered, LVEF 68%
Inciardi et al 35 Italy53FNoneFever, dry cough, fatigue, hypotensive, normal oxygen saturationLow voltage, diffuse ST-elevation, ST depression in V1 and aVRCXR: normal;
CMR: LVH, BiV hypokinesis LVEF: 35%, BiV myocardial oedema, diffuse LGE
hs-TnT, NT-proBNP, elevatedMyopericarditisAntiviral, corticosteroid, CQ, dobutamine, medical treatment for HFImproved, LVEF 44% on day 6
Fried et al 32 USA64FHTN, hyperlipidaemiaChest pressure, afebrile, no respiratory symptoms, normal oxygen saturationSinus tachycardia, low QRS voltage, diffuse ST and PR elevations, ST depression in aVRCXR: 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 elevatedMyopericarditis, with cardiogenic shockIABP, dobutamine, HCQRecovered, LVEF 50% on day 10
Fried et al 32 USA38MDMCough, chest pain, dyspnoea, rapidly deteriorated respiratory statusSVT, Sinus tachycardia, AIVRCXR: 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 elevatedStress cardiomyopathyHCQ, invasive ventilation and VV ECMO, after LV function deterioration, change to VAV ECMODecannulated from ECMO after 7 days, stable, remain on mechanical ventilation
Fried et al 32 USA64FNICM with normal LVEF, AF, HTN, DMNon-productive cough, afebrile, dyspnoea, oxygen saturation 88%Sinus, PVC, PAC, lateral T inversion, QTc 528 msCXR: bibasilar opacities, vascular congestion
TTE: severely reduced LV function
TnT, NT-proBNP, ferritin elevatedDecompensated heart failureBroad-spectrum antibiotics, nitroglycerin, furosemide, mechanical ventilation, vasopressorRemain intubated on day 9
Fried et al 32 USA51MHeart and renal transplantFever, dry cough, dyspnoeaNew T-wave inversionTTE: normal cardiac allograft functionhs-TnT, IL-6, NT-proBNP, ferritin elevatedMyocarditis?MMF discontinued, HCQ, azithromycin, ceftriaxoneDischarged
Sala et al 33 Italy43FNoneChest pain, dyspnoea, oxygen saturation 89%Sinus, new non-specific T-wave changesCXR: 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 elevatedMyocarditisCPAP, antiviral, HCQDischarged
  • 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.