Associazione Nazionale Medici Cardiologi Ospedalieri

congress.anmco.it

CONGRESS ABSTRACT

CONGRESS ABSTRACT

FULMINANT MYOCARDITIS DURING COVID-19 OUTBREAKS: MYTHS OR REALITY?

Menghi Caterina Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Giordani Andrea Silvio Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Baritussio Anna Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | De Gaspari Monica Padova (Pd) – Cardiovascular Pathology, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Federico Scognamiglio Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Vicenzetto Cristina Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Bison Elisa Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Cattini Peloso Maria Grazia Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Pontara Elena Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Marcolongo Renzo Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Rizzo Stefania Padova (Pd) – Cardiovascular Pathology, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Basso Cristina Padova (Pd) – Cardiovascular Pathology, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova | Caforio Alida Linda Patrizia Padova (Pd) – Cardiology And Cardioimmunology Laboratory, Department Of Cardiac Thoracic Vascular Sciences And Public Health, University Of Padova

Background :Although infections are established triggers, the etiopathogenetic role of SARS-CoV-2 in fulminant myocarditis (FM) remains unproven. Moreover, the concordance between SARS-CoV-2 detection on nasopharyngeal swabs and its identification by molecular analysis of endomyocardial biopsy (EMB) has not been systematically investigated. Aims :To compare clinical characteristics, diagnostic findings, and outcomes of FM cases before and after the COVID-19 pandemic in a tertiary referral center. To assess concordance between SARS-CoV-2 detection by serological or molecular testing on nasopharyngeal swabs and viral polymerase chain reaction (PCR) on EMB specimens. Methods :We retrospectively analyzed FM cases diagnosed between 2001 and 2025, comparing patients diagnosed before and after March 2020. The primary composite outcome included cardiac death, heart transplantation, or myocarditis relapse. Results :Forty-six FM patients (61% male; median age 36 years) were included; 17 (37%) were diagnosed after March 2020. Clinical presentation and diagnostic features were comparable between cohorts. Ventricular fibrillation and ventricular tachycardia occurred in 53% and 33% of patients, respectively. Median left ventricular ejection fraction (LVEF) was 40.0% [27.5–47.0]. Troponin and C-reactive protein were elevated in 89% and 79% of patients, respectively. EMB was performed in 78% of patients, showing predominantly lymphocytic myocarditis (83%), followed by giant-cell (14%) and eosinophilic (3%) forms, without differences between periods. Viral genomes were detected in 26% of EMBs, most commonly parvovirus B19 and enterovirus; SARS-CoV-2 was not identified in any myocardial specimen, including two patients with concurrent SARS-CoV-2 infection. Thirteen patients had received COVID-19 vaccination, with no post-vaccination myocarditis. Immunosuppressive therapy was administered in 28% of patients. Over a median follow-up of 34 months, the composite outcome occurred in 35% of patients, with no differences between pre- and post-pandemic cohorts. On multivariable analysis, baseline LVEF was the only independent predictor of adverse outcome (HR 0.94; 95% CI 0.90–0.98; p = 0.010). Conclusions : FM patients showed similar clinical presentation, histopathology, and outcomes before and after the COVID-19 pandemic. The absence of myocardial SARS-CoV-2 detection despite positive nasopharyngeal testing argues against a direct causal role of SARS-CoV-2 in FM within this cohort.