Contradictory information on post covid myocarditis

The Incidence of Myocarditis and Pericarditis in Post COVID-19 Unvaccinated Patients-A Large Population-Based Study

https://pubmed.ncbi.nlm.nih.gov/35456309/

The authors declare no conflict of interest.

Myocarditis and pericarditis are potential post-acute cardiac sequelae of COVID-19 infection,

arising from adaptive immune responses.

We aimed to study the incidence of post-acute COVID-19 myocarditis and pericarditis.

Retrospective cohort study

N = 196,992 adults after COVID-19 infection

Clalit Health Services members in Israel

March 2020 and January 2021

The control cohort (no infection)

N = 590,976 adults

Age- and sex-matched

COVID infection cohort

Nine post-COVID-19 patients developed myocarditis (0.0046%)

Eleven patients were diagnosed with pericarditis (0.0056%).

Non- COVID infection cohort

27 patients had myocarditis (0.0046%)

52 had pericarditis (0.0088%)

Age adjusted hazard ratio

0.96

95% confidence interval, 0.93 to 1.00

Male sex, aHR 4.42; were associated with myocarditis

Male sex aHR 1.93; were associated with pericarditis

Post COVID-19 infection was not associated with either myocarditis or pericarditis

aHR 1.08; for myocarditis

aHR 0.53; for myocarditis

We did not observe an increased incidence of neither pericarditis nor myocarditis in adult patients recovering from COVID-19 infection.

Myocarditis and pericarditis (21st March 2022)

https://www.gov.uk/government/publications/covid-19-vaccination-myocarditis-and-pericarditis-information-for-healthcare-professionals/information-for-healthcare-professionals-on-myocarditis-and-pericarditis-following-covid-19-vaccination

In 2017

https://www.ahajournals.org/doi/10.1161/circ.140.suppl_1.11463

About 2,000 hospital admissions for myocarditis

Two-thirds of cases were in men

Median age for men, 33

Mostly viral

https://www.mdpi.com/2077-0383/10/4/603

Presentation of acute myocarditis

Subclinical disease too,

heart failure, chest pain, shortness of breath, palpitations and fatigue.

Dilated cardiomyopathy and chronic heart failure

Sudden death syndrome

https://www.sciencedirect.com/science/article/abs/pii/S0033062009000966?via%3Dihub

Myocarditis implicated in 12% of sudden deaths under the age of 40

Acute pericarditis

Often similar presentation

Some concurrent myocardial involvement (myopericarditis)

Constrictive pericarditis is uncommon

https://heart.bmj.com/content/101/14/1159

Can myocarditis or pericarditis be caused by coronavirus (COVID-19) infection?

It is now recognised that COVID-19 infection can lead to myocarditis or pericarditis

https://pubmed.ncbi.nlm.nih.gov/34516657/

Professional athletes are an atypical group

Published online 2021 May 27

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160916/

1,597 athletes with recent SARS-CoV-2 infection

(March 1, 2020, through December 15, 2020)

0.31% were diagnosed with myocarditis using a symptom-based screening

2.3% were diagnosed with clinical or subclinical myocarditis using cardiac magnetic resonance screening

Is there an association of myocarditis or pericarditis following COVID-19 vaccination?

Many studies have now shown that there is an increased risk of myocarditis following vaccination with an mRNA vaccine,

https://www.nejm.org/doi/full/10.1056/NEJMoa2110737

https://www.cdc.gov/mmwr/volumes/70/wr/mm7027e2.htm

https://www.nejm.org/doi/full/10.1056/NEJMoa2109730

https://www.gov.uk/government/publications/myocarditis-and-pericarditis-after-covid-19-vaccination

especially in young men under the age of 40.

Many of the studies have only limited follow up ……