Hospital Registry of Acute Myocarditis: Evolution of the Proportion of Positive SARS-COV-2 (COVID19) Cases

Although research on the subject has only recently started developing, the links have already
been described between SARS-Cov-2 infection, the severity of the clinical status, and the
presence of risk factors or a history of cardiovascular disease (hypertension, diabetes,
stroke, etc.). Additionally, depending on the series and definition used for cardiac injury
(troponin elevation and/or natriuretic peptides), this concerns 7-29% of patients with a
clear predominance in severe patients. The mechanisms behind these troponin elevations and
cardiac injury are likely to be multiple and variable depending on clinical
presentation,severity and patient history. A significant association was found between
troponin elevation, and that of CRP and NtproBNP, suggesting an inflammatory part to this
cardiac damage. As with other coronaviruses, SARS-Cov-2 infection can cause massive release
of proinflammatory cytokines which can lead to inflammation of the vascular wall. This can be
the cause of true instability or even rupture of plaque(type1 infarction) but can also be
responsible for tissue hypoxia without rupture of plaque causing myocardial pain (infarction
type 2). In addition, there may be areal myocardial inflammation causing acute myocarditis,
secondary to the cytokine storm or direct damage to the myocardium by the virus itself. In
case of acute coronary syndrome presentation, a coronary exploration should be realized to
highlight or eliminate a type 1 infarction, but it is clearly difficult to distinguish
between a type 2 suffering (no viral attack direct but suffering from hypotension or hypoxia
for example) and inflammatory myocardial damage with or without direct viral myocardial
damage (myocarditis). In the context of the viral pandemic at Covid19, although few data
exist,it is legitimate to consider the possibility of true arrays of acute inflammatory
myocarditis or by direct viral attack which could thus modify the natural history and the
prognosis of patients, thus justifying a dedicated diagnosis and treatment. The primary
objective was to assess the proportion of positive SARS-Cov-2 cases among the patients
included (hospitalized for acute myocarditis). During the study period, this proportion will
be assessed at regular intervals, for example every month, or more frequently if the number
of patients included varies substantially from one week to another. This will make it
possible to trace a development curve for the entire period of the pandemic.

The secondary objectives were (1) to describe the clinical, biological and imaging
characteristics of the acute myocarditis among the positive and negative SARS-Cov-2 patients
of the myocarditis cohort; (2) to assess the short-term (30 days) and long-term (1 year)
prognosis of the acute myocarditis among the positive and negative SARS-Cov-2 patients of the
myocarditis cohort and (3) to identify the factors associated with a 30-day and 1-year
prognosis of cases of acute myocarditis.