Evidence of SARS-CoV-2 mRNA in endomyocardial biopsies of patients with clinically suspected myocarditis tested negative for COVID-19 in nasopharyngeal swab

P Wenzel, S Kopp, S Göbel, T Jansen… - Cardiovascular …, 2020 - academic.oup.com
P Wenzel, S Kopp, S Göbel, T Jansen, M Geyer, F Hahn, KF Kreitner, F Escher…
Cardiovascular research, 2020academic.oup.com
Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can
cause coronavirus disease 2019 (COVID-19). 1 Myocardial injury—observed in up to 7–
17% of patients with COVID-192—is associated with increased morbidity and mortality due
to COVID-19, which is highest among patients with known cardiovascular disease (CVD),
but also includes patients without known CVD. 3 Recent reports described cases of acute
myocarditis in COVID-19, sometimes with a fulminant course, that occur between 4 and 9 …
Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause coronavirus disease 2019 (COVID-19). 1 Myocardial injury—observed in up to 7–17% of patients with COVID-192—is associated with increased morbidity and mortality due to COVID-19, which is highest among patients with known cardiovascular disease (CVD), but also includes patients without known CVD. 3 Recent reports described cases of acute myocarditis in COVID-19, sometimes with a fulminant course, that occur between 4 and 9 days after initial symptoms. 2, 4, 5
We here report cases of two patients admitted to our tertiary medical centre, the University Medical Center Mainz, Germany. Both patients were male, 39 and 36 years old, had shortness of breath, T-wave inversions in the anterolateral leads on ECG, elevated serum levels of natriuretic peptides and cardiac troponin I, as well as echocardiographic signs of left ventricular (LV) dysfunction (decreased global and regional longitudinal strain or reduced LV ejection fraction and increased LV enddiastolic diameter). Both patients were obese and had a history of upper airway infection with headache, fever, and cough up to 4 weeks before admission. Patient B had more pronounced cardiovascular risk factors and co-existing coronary heart disease (Supplementary material online, Table S1 and Figure S1). Cardiac magnetic resonance imaging and mapping analysis were compatible with clinically suspected myocarditis (Figure 1 A). Nasopharyngeal swab was repeatedly tested negative for SARS-CoV-2 mRNA by reverse transcription–polymerase chain reaction (RT–PCR; Altona Diagnostics; Hamburg, Germany), and negative for influenza A and B, respiratory syncytial virus (RSV), metapneumovirus, and parainfluenza virus when patients presented with clinically suspected myocarditis 4 weeks after possible COVID-19 disease. Endomyocardial biopsies were taken based on the recommendation of
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