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Inflamação miocárdica no contexto de infeção a SARS-CoV-2 (COVID-19)
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O diagnóstico de miocardite continua um desafio, nomeadamente pela sua apresentação heterogénea e confundente. Acompanhando-se não raramente também por inflamação do pericárdio, a inflamação do miocárdio tem ganho cada vez mais relevância por se assumir como uma das potenciais consequências da infeção por SARS-CoV-2 (COVID-19). Neste estudo retrospetivo efectuado num Centro Hospitalar Universitário, foram analisados os processos de 39 doentes internados por inflamação miocárdica (com ou sem pericardite associada) no período compreendido entre 1 de Março de 2019 e 31 de Agosto de 2021 e divididos em dois grupos: o primeiro (o grupo designado por“pré-covid-19”) que consistiu no grupo de doentes internados nos 12 meses anteriormente ao primeiro caso de infeção a covid-19 identificado em Portugal; e o segundo (designado por grupo “pós covid-19”) que consistiu no grupo de doentes internados nos 18 meses após o primeiro caso de covid-19 identificado em Portugal. Para a análise estatística utilizaram-se: o teste de Fisher e Coeficiente V de Cramer, o teste de Shapiro-Wilk e o teste de Mann-Whitney . Em termos de resultados significativos realça-se: uma redução de 43% em internamentos por miocardite (com ou sem pericardite) ou pericardite isolada, desde o primeiro caso covid-19; a existência no grupo “pré- Covid-19” de infra-desnivelamento do segmento PR (infra_PR) em 17% dos doentes vs 10% no grupo “pós Covid-19” (Teste de Fisher: P= 0,046, coeficiente de Cramer: P=0,038); a existência no grupo “pré- Covid-19,” de supra-desnivelamento do segmento ST (supra-ST) com concavidade superior em 18 % dos doentes vs 58% no grupo “pós Covid-19”(Teste de Fisher: P= 0,018 , coeficiente de Cramer: P=0,018); e a existência no grupo “pré-Covid-19,” de 61% dos doentes com medicação em ambulatório no momento de alta, e no grupo “pós Covid” de 81%. (Teste de Fisher: P=0,007 e o coeficiente de Cramer: P=0,007). Coloca-se a possibilidade das medidas de confinamento e higiene, menor afluência ás urgências e vacinação contra o SARS-COV2 poderem ter exercido influência na incidência de inflamação miopericárdica.
Myocarditis is a diagnosis that remains a challenge due to its heterogeneous presentation. The myocardial inflammation, not rarely accompanied by pericardial inflammation, has been gaining more relevance mainly because of its role as a potential consequence of SARS-CoV-2 infection. In this retrospective study, conducted in a University Hospital Center, the admission files of 39 patients admitted with myocardial inflammation (with or without pericardial inflammation), between 1st of March of 2019 and the 31st of August of 2021, were revised and divided into 2 groups: the first (designated as the “pré-covid-19” group) which included the patients admitted during the 12 months prior to the first covid-19 case identified in Portugal, and the second (designated as the “pós-covid-19” group), which included the patients admitted during the 18 month after the first covid-19 case identified in Portugal. The tests used for the statistical analysis were: Exact Fisher, Cramer`V , Shapiro-Wilk test and the Mann-Whitney test. When it comes to significant results the highlights are: a 43% reduction in admissions for myocarditis (with or without associated pericarditis), or pericarditis, since the first covid-19 case ; the existence in the “pré-covid-19” group, of 17% of patients with PR segment depression (Infra-PR), vs 10% in the” pós-covid-19” group (Exact Fisher: P= 0,046 , Cramer`s V: P=0,038), the existence in the “pré-covid-19 “group of 18% of patients with concave ST-segment elevation, vs 58% in the “póscovid- 19” (Exact Fisher: P= 0,018 , Cramer`: P=0,018) and the existence in the “précovid- 19” group of 61% of patients that were discharged with outpatient medication, and in the “pós-covid-19” group, of 81% (Exact Fisher: P=0,007 , Cramer`s V: P=0,007). It is hypothesized that confinement and hygiene measures, a lower affluence to the ER and the vaccination against SARS-COV2, have potentially played a part influencing the incidence values of miopericardial inflammation.
Myocarditis is a diagnosis that remains a challenge due to its heterogeneous presentation. The myocardial inflammation, not rarely accompanied by pericardial inflammation, has been gaining more relevance mainly because of its role as a potential consequence of SARS-CoV-2 infection. In this retrospective study, conducted in a University Hospital Center, the admission files of 39 patients admitted with myocardial inflammation (with or without pericardial inflammation), between 1st of March of 2019 and the 31st of August of 2021, were revised and divided into 2 groups: the first (designated as the “pré-covid-19” group) which included the patients admitted during the 12 months prior to the first covid-19 case identified in Portugal, and the second (designated as the “pós-covid-19” group), which included the patients admitted during the 18 month after the first covid-19 case identified in Portugal. The tests used for the statistical analysis were: Exact Fisher, Cramer`V , Shapiro-Wilk test and the Mann-Whitney test. When it comes to significant results the highlights are: a 43% reduction in admissions for myocarditis (with or without associated pericarditis), or pericarditis, since the first covid-19 case ; the existence in the “pré-covid-19” group, of 17% of patients with PR segment depression (Infra-PR), vs 10% in the” pós-covid-19” group (Exact Fisher: P= 0,046 , Cramer`s V: P=0,038), the existence in the “pré-covid-19 “group of 18% of patients with concave ST-segment elevation, vs 58% in the “póscovid- 19” (Exact Fisher: P= 0,018 , Cramer`: P=0,018) and the existence in the “précovid- 19” group of 61% of patients that were discharged with outpatient medication, and in the “pós-covid-19” group, of 81% (Exact Fisher: P=0,007 , Cramer`s V: P=0,007). It is hypothesized that confinement and hygiene measures, a lower affluence to the ER and the vaccination against SARS-COV2, have potentially played a part influencing the incidence values of miopericardial inflammation.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
SARS-CoV-2 Miocardite Pericardite Miopericardite Miocárdio Cardiologia