Corticosteroid Therapy in Management of Myocarditis Associated with COVID-19; a Systematic Review of Current Evidence
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
Introduction: Myocarditis in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seems to be associated with a higher mortality rate. This study aims to summarize the latest evidence on whether the use of corticosteroids in patients with myocarditis associated with COVID-19 is necessary.
Methods: We performed an extensive search using a combination of search terms in PubMed, Europe PMC, ProQuest, EBSCOhost, and Google Scholar up to January 2021. Full-text articles that met the predefined inclusion criteria were included in the present study.
Results: The full-texts of 18 articles have been reviewed. Thirteen out of the eighteen (72%) patients who got corticosteroid administration experienced major clinical improvements during follow-up while the other five (28%) were experiencing uneventful events. The mean age of the reported patients was 47.8±13.2 years. There was no gender predominance. Most of the reported cases were from USA (39%) followed by Spain, China, and UK (11% each), while Brazil, Colombia, France, Belgium, and Italy contributed one case each. Various corticosteroids were used but the most commonly applied were methylprednisolone (89%), hydrocortisone (5.5%), and prednisolone (5.5%). The most common route of administration among the studies was intravenous administration and the duration of treatment varied between one and fourteen days.
Conclusion: A review of the currently available literature shows that with the use of corticosteroid agents in treating myocarditis associated with COVID-19, favorable outcomes are attainable. Well-established randomized clinical trials are needed to evaluate the efficacy and safety of using corticosteroids in this condition.
- adrenal cortex hormones
- drug therapy
How to Cite
WHO. Coronavirus disease (COVID-19) pandemic 2020 [Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
WHO. Situation Reports 2020 [Available from: https://www.who.int/indonesia/news/novel-coronavirus/situation-reports.
Mokhtari T, Hassani F, Ghaffari N, Ebrahimi B, Yarahmadi A, Hassanzadeh G. COVID-19 and multiorgan failure: A narrative review on potential mechanisms. Journal of molecular histology. 2020;51(6):613-28.
Mai F, Del Pinto R, Ferri C. COVID-19 and cardiovascular diseases. J Cardiol. 2020;76(5):453-8.
Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405-7.
Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097.
Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, et al. Cochrane Handbook for Systematic Reviews of Interventions 2nd Edition. Chichester (UK): John Wiley & Sons; 2019.
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Case Reports [Available from: https://joannabriggs.org/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Case_Reports2017_0.pdf.
Bernal-Torres W, Herrera-Escandón Á, Hurtado-Rivera M, Plata-Mosquera CA. COVID-19 fulminant myocarditis: a case report. Eur Heart J Case Rep. 2020;4(Fi1):1-6.
Coyle J, Igbinomwanhia E, Sanchez-Nadales A, Danciu S, Chu C, Shah N. A Recovered Case of COVID-19 Myocarditis and ARDS Treated With Corticosteroids, Tocilizumab, and Experimental AT-001. JACC Case Rep. 2020;2(9):1331-6.
Doyen D, Moceri P, Ducreux D, Dellamonica J. Myocarditis in a patient with COVID-19: a cause of raised troponin and ECG changes. Lancet. 2020;395(10235):1516-.
Garau G, Joachim S, Duliere G-L, Melissopoulou M, Boccar S, Fraipont V, et al. Sudden cardiogenic shock mimicking fulminant myocarditis in a surviving teenager affected by severe acute respiratory syndrome coronavirus 2 infection. ESC heart failure. 2021;8(1):766-73.
Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Eur Heart J. 2021;42(2):206.
Hussain H, Fadel A, Alwaeli H, Guardiola V. Coronavirus (COVID-19) Fulminant Myopericarditis and Acute Respiratory Distress Syndrome (ARDS) in a Middle-Aged Male Patient. Cureus. 2020;12(6):e8808-e.
Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):819-24.
Khalid N, Chen Y, Case BC, Shlofmitz E, Wermers JP, Rogers T, et al. COVID-19 (SARS-CoV-2) and the Heart - An Ominous Association. Cardiovasc Revasc Med. 2020;21(8):946-9.
Khatri A, Wallach F. Coronavirus disease 2019 (Covid-19) presenting as purulent fulminant myopericarditis and cardiac tamponade: A case report and literature review. Heart Lung. 2020;49(6):858-63.
Li A, Garcia-Bengochea Y, Stechel R, Azari BM. Management of COVID-19 myopericarditis with reversal of cardiac dysfunction after blunting of cytokine storm: a case report. Eur Heart J Case Rep. 2020;4(Fi1):1-6.
Naneishvili T, Khalil A, Leary R, Prasad N. Fulminant myocarditis as an early presentation of SARS-CoV-2. BMJ case reports. 2020;13(9):e237553.
Irabien-Ortiz Á, Carreras-Mora J, Sionis A, Pàmies J, Montiel J, Tauron M. Fulminant myocarditis due to COVID-19. Rev Esp Cardiol (Engl Ed). 2020;73(6):503-4.
Richard I, Robinson B, Dawson A, Aya A, Ali R. An Atypical Presentation of Fulminant Myocarditis Secondary to COVID-19 Infection. Cureus. 2020;12(7):e9179-e.
Salamanca J, Díez-Villanueva P, Martínez P, Cecconi A, González de Marcos B, Reyes G, et al. COVID-19 "Fulminant Myocarditis" Successfully Treated With Temporary Mechanical Circulatory Support. JACC Cardiovasc Imaging. 2020;13(11):2457-9.
Sampaio PPN, Ferreira RM, Albuquerque FN, Colafranceschi AS, Almeida ACP, Nunes MAV, et al. Rescue venoarterial extracorporeal membrane oxygenation after cardiac arrest in COVID-19 myopericarditis: A case report. Cardiovasc Revasc Med. 2020.
Shabbir A, Camm CF, Elkington A, Tilling L, Stirrup J, Chan A, et al. Myopericarditis and myositis in a patient with COVID-19: a case report. European Heart Journal - Case Reports. 2020;4(6):1-6.
Tavares M, Otuonye G, Ayyagari L, Lofters J, Lui J. FULMINANT MYOCARDITIS IN A PATIENT WITH SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2. Chest. 2020;158(4):A443-A4.
Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020;48(5):773-7.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med. 2020.
ESC. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic 2020 [Available from: https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance.
- Abstract Viewed: 1334 times
- pdf Downloaded: 689 times