Pericardial and myocardial involvement after SARS-CoV-2 infection: a cross-sectional descriptive study in health care workers

Introduction and objectives: The cardiac sequelae of SARS-CoV-2 infection are still poorly documented. We conducted a cross-sectional study in health care workers to report evidence of pericardial and myocardial involvement after SARS-CoV-2 infection. Methods: We studied 139 health care workers with confirmed past SARS-CoV-2 infection. Participants underwent clinical assessment, electrocardiography, and laboratory tests, including immune cell profiling and cardiac magnetic resonance (CMR). Clinically suspected pericarditis was diagnosed when classic criteria were present and clinically suspected myocarditis was based on the combination of at least 2 CMR criteria. Results: Median age was 52 (41-57) years, 71.9% were women, and 16.5% were previously hospitalized for COVID-19 pneumonia. On examination (10.4 [9.3-11.0] weeks after infection-like symptoms), participants showed hemodynamic stability. Chest pain, dyspnea or palpitations were present in 41.7% participants, electrocardiographic abnormalities in 49.6%, NT-proBNP elevation in 7.9%, troponin in 0.7%, and CMR abnormalities in 60.4%. A total of 30.9% participants met criteria for either pericarditis and/or myocarditis: isolated pericarditis was diagnosed in 5.8%, myopericarditis in 7.9%, and isolated myocarditis in 17.3%. Most participants (73.2%) showed altered immune cell counts in blood, particularly decreased eosinophil (27.3%;P < .001) and increased cytotoxic T cell numbers (17.3%;P < .001). Clinically suspected pericarditis was associated (P < .005) with particularly elevated cytotoxic T cells and decreased eosinophil counts, while participants diagnosed with clinically suspected myopericarditis or myocarditis had lower (P < .05) neutrophil counts, natural killer-cells, and plasma cells. Conclusions: Pericardial and myocardial involvement with clinical stability are frequent after SARS-CoV-2 infection and are associated with specific immune cell profiles. Resumen Introduccion y objetivos: Las secuelas cardiacas tras la infeccion por SARS-CoV-2 todavia estan poco documentadas. Se realizo un estudio transversal en trabajadores sanitarios para estudiar la prevalencia de afectacion pericardica y miocardica tras la infeccion por SARS-CoV-2. Metodos: Se estudio a 139 trabajadores sanitarios con infeccion previa confirmada por SARS-CoV-2. Los participantes se sometieron a evaluacion clinica, electrocardiograma, laboratorio, incluido el perfil de celulas inmunitarias, y resonancia magnetica cardiaca (RMC). El diagnostico clinico de pericarditis se realizo ante la presencia de los criterios clasicos y el diagnostico clinico de miocarditis ante la presencia de al menos 2 criterios de RMC. Resultados: La mediana de edad fue de 52 (41–57) anos, el 71,9% eran mujeres, y el 16.5% habia sido hospitalizado previamente por neumonia COVID-19. En la evaluacion (10,4 [9,3–11,0] semanas despues de los sintomas de infeccion), todos participantes presentaban estabilidad hemodinamica. El 41,7% presentaba dolor toracico, disnea o palpitaciones;el 49,6%, alteraciones electrocardiograficas;el 7,9%, elevacion de NT-proBNP;el 0,7%, elevacion de troponina;y el 60,4%, alteraciones en la RMC. Un total de 30,9% de participantes cumplieron los criterios clinicos establecidos de pericarditis o miocarditis: pericarditis aislada en el 5,8%, miopericarditis en el 7,9% y miocarditis aislada en el 17,3%. La mayoria de los participantes (73,2%) mostraron recuentos de celulas inmunitarias alterados en sangre;en particular diminucion de eosinofilos (27,3%;p < 0,001) y aumento del numero de celulas T citotoxicas (17,3%;p < 0,001). La sospecha clinica de pericarditis se asocio (p < 0,005) particularmente con un elevado numero de celulas T citotoxicas y recuento de eosinofilos disminuidos;mientras que los participantes con sospecha clinica de miopericarditis o miocarditis tenian recuentos de neutrofilos, celulas natural killer y celulas plasmaticas mas bajos (p < 0,05). Conclusiones: La afectacion pericardica y miocardica con estabilidad hemodinamica es frecuente despues de la infeccion por SARS-CoV-2 y se asocia con perfiles de celulas inmunitarias especificas.