(CCSP088) ACUTE MYO/PERICARDITIS IN POST-ACUTE COVID-19 SYNDROME; INSIGHTS FROM THE IMPACT STUDY.

Background: Ongoing inflammation of the myocardium and pericardium (myo/pericarditis) have been reported in patients suffering from Post-Acute COVID-19 Syndrome (PACS). We aim to: 1) determine the prevalence of acute myo/pericarditis in patients with PACS and symptoms suggestive of potential cardiovascular diseases (CVD), 2) identify factors associated with acute myo/pericarditis and 3) determine the predictive values of inflammatory biomarkers in PACS-related acute myo/pericarditis.

METHODS AND RESULTS: IMPACT-COVID-19 is a prospective longitudinal cohort study enrolling adults with confirmed COVID-19 infection and PACS, with at least one symptom suggestive of potential CVD (dyspnea, palpitations, chest pain, or dizziness). The study is ongoing at McGill University Hospital Center and Centre Hospitalier Universitaire de Sherbrooke. We measured inflammatory, cardiac biomarkers, and echocardiograms at baseline visits. We obtained cardiac magnetic resonance imaging (CMR) within 8 months following the baseline visit. We defined acute myo/pericarditis as acute myo/pericarditis on CMR (Lake Louise criteria) or chest pain with elevated inflammatory biomarkers or pericardial effusion on echocardiogram. We performed multivariate logistic regressions to determine clinical characteristics associated with acute myo/pericarditis, and computed receiver operating curves (ROC) for erythrocyte sedimentation rate (ESR), c-reactive protein (CRP).

The following results were based on the first 256 patients enrolled. The majority were females (73%), and Whites (86%) with a mean age of 45 years. Enrollment occurred after a median interval of 279 days (25th, 75th percentiles: 189, 400). One hundred and three patients (40%) required an emergency room (ER) visit for their acute infection; thirty-eight patients were hospitalized for the index COVID-19 infection (15%). Seventy-six patients (30%) had acute myo/pericarditis. Visit to ER was independently associated with increased prevalence of acute myopericarditis: (odds ratio: 2.39 (95% confidence intervals: 1.21, 4.72). ESR was elevated in patients with acute myo/pericarditis compared to patients without acute myo/pericarditis (18 mm/h vs 12 mm/h; p:0.02). CRP was non-discriminating for acute myo/pericarditis (1.85 mg/L for patients with acute myo/pericarditis versus 1.54 mg/L for patients without acute myo/pericarditis, p:0.51). ROC c-statistics were 0.61 for ESR and 0.49 for CRP (Figures 1-2). An ESR of ≥14 mm/h had the best predictive value for acute myopericarditis.

Conclusion: Acute myo/pericarditis was frequent in patients with PASC with either dyspnea, chest pain, palpitation, or dizziness. COVID-19 infection requiring ER visit is associated with an increased prevalence of acute myo/pericarditis. Increased ESR has a better predictive value compared to CRP for myo/pericarditis. Our findings suggest including ESR measurement in the diagnostic evaluation of PACS-associated acute myo/pericarditis.