@article{3100634,
    title = "COVID-19 and myocarditis: a systematic review and overview of current challenges",
    author = "Castiello, T. and Georgiopoulos, G. and Finocchiaro, G. and Claudia, M. and Gianatti, A. and Delialis, D. and Aimo, A. and Prasad, S.",
    journal = "Heart Failure Reviews",
    year = "2022",
    volume = "27",
    number = "1",
    pages = "251-261",
    publisher = "Springer-Verlag",
    issn = "1382-4147",
    doi = "10.1007/s10741-021-10087-9",
    keywords = "cardiovascular magnetic resonance;  clinical feature;  coronavirus disease 2019;  disease severity;  echocardiography;  electrocardiogram;  heart muscle biopsy;  histology;  human;  incidence;  mortality rate;  myocarditis;  Review;  risk factor;  systematic review;  cardiac muscle cell;  male;  myocarditis;  register, COVID-19;  Humans;  Male;  Myocarditis;  Myocytes, Cardiac;  Registries;  SARS-CoV-2",
    abstract = "Myocardial inflammation in COVID-19 has been documented. Its pathogenesis is not fully elucidated, but the two main theories foresee a direct role of ACE2 receptor and a hyperimmune response, which may also lead to isolated presentation of COVID-19-mediated myocarditis. The frequency and prognostic impact of COVID-19-mediated myocarditis is unknown. This review aims to summarise current evidence on this topic. We performed a systematic review of MEDLINE and Cochrane Library (1/12/19–30/09/20). We also searched clinicaltrials.gov for unpublished studies testing therapies with potential implication for COVID-19-mediated cardiovascular complication. Eligible studies had laboratory confirmed COVID-19 and a clinical and/or histological diagnosis of myocarditis by ESC or WHO/ISFC criteria. Reports of 38 cases were included (26 male patients, 24 aged < 50 years). The first histologically proven case was a virus-negative lymphocytic myocarditis; however, biopsy evidence of myocarditis secondary to SARS-CoV-2 cardiotropism has been recently demonstrated. Histological data was found in 12 cases (8 EMB and 4 autopsies) and CMR was the main imaging modality to confirm a diagnosis of myocarditis (25 patients). There was a substantial variability in biventricular systolic function during the acute episode and in therapeutic regimen used. Five patients died in hospital. Cause-effect relationship between SARS-CoV-2 infection and myocarditis is difficult to demonstrate. However, current evidence demonstrates myocardial inflammation with or without direct cardiomyocyte damage, suggesting different pathophysiology mechanisms responsible of COVID-mediated myocarditis. Established clinical approaches should be pursued until future evidence support different actions. Large multicentre registries are advisable to elucidate further. © 2021, The Author(s)."
}