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P217 Table 1Case series outcomes table Case no. IFX dose& regime Follow-up duration (months) Change in prednisolone dose Change in FDG-PET uptake Change in LV systolic function Change in arrythmia burden Adverse events Composite Endpoint Dose pre-IFX(mg) Dose post-IFX(mg) Pre-IFX Post-IFX LVEF pre-IFX (%) LVEF post-IFX(%) Pre-IFX Post-IFX Infections Heart failure VT/VF (requiring device) All-cause mortality Aborted SCD (device) Cardiac Transplant Case 1 IFX 3 mg/kg every 8 weeks (break after 10th dose due to covid pandemic;restarted 3 months later) 29 20 15 Active CS(SUVmax 11.1) Improvement(SUVmax3.5) 58 59 N/A N/A 0 0 0 0 0 0 Case 2 IFX 3 mg/kg every 8 weeks. Stopped after 15.6 months due to resolution 15.6 10 10 Active CS(SUVmax 10.2) Improvement(SUVmax 2.65) 55 62 VA 0 1 (chest infection) 0 0 0 0 0 Case 2Relapse (7 months after stopping IFX) due to VT and FDG uptake IFX 3 mg/kg every 8 weeks 12 10 10 Active CS(SUVmax 3.3) Improvement(no uptake) N/A 50 VA 0 0 Mild LVSD 0 0 0 0 Case 3 IFX 3 mg/kg0 weeks and 4 weeks;missed 8 weeks’ appointment due to COVID-19 10 20 20 Active CS(SUVmax 11.3) N/A 55 N/A 0 N/A 1 (Covid-19) 0 0 0 0 0 Case 4 IFX 3 mg/kg at 0, 2 and 8 weeks afterwards 16 20 10 Active CS(SUVmax 13) Improved(SUVmax 3.4) 45 66 VA N/A 0 0 0 1 (PFO and shunt/complications) 0 0 Case 5 IFX 3 mg/kg 0, 2, 6 and every 8 weeks 8.5 30 15 Active CS(SUVmax 11.3) Improved(no uptake) 46 51 VA 0 0 0 0 0 0 0 Totals 6 IFX 3 mg/kg Mean=15.2 Mean=18.3 Mean=13.3 All had active CS 5 improved;1 data not available Mean=51.8 Mean=57.6 4 had VAs;1 data not available None had VA;3 had data not available 2 1 0 1 0 0 CS = cardiac sarcoidosis;FDG-PET =fluorodeoxyglucose positron emission tomography;IFX = Infliximab;LV = left ventricular;LVEF = left ventricular ejection fraction;LVSD = left ventricular systolic dysfunction;N/A = data not available;PFO= patent foramen ovale;
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Introduction: Acute myocarditis has been reported in patients infected with COVID-19 in case series and imaging-based studies. We sought to assess this link by evaluating trends in hospital admissions due to acute myocarditis and COVID-19 on a national level during the pandemic. Methods: Data on all NHS England hospital admissions with a primary or secondary diagnosis of acute myocarditis were acquired and curated from the NHS Digital hospital episode statistics dataset from 2019-2020. COVID-19 data was obtained from the UK government daily statistics. Rolling averages over 28-day periods are presented. Results: Across all ages, there were 1,894 hospital admissions due to myocarditis in 2019 compared with 1,610 in 2020 (15% reduction). During the first national lockdown (23rdMar-19thJun 2020), myocarditis admissions were 32% lower than the same period in 2019. During the second lockdown (5thNov-2ndDec), myocarditis admissions were 9% greater than in 2019, although this increase was not sustained throughout December despite the subsequent surge in COVID-19 admissions. In general, patients admitted in 2020, compared to 2019, were older (median age 46 years, interquartile range 28-61 vs 41 years, IQR 26-58;p<0.001), but sex (66% men), ethnicity (39% non-Caucasian, 9% unknown) and duration of hospital admission (median 2 days;IQR 1-4) were similar for both years. Discussion: As COVID-19 admissions peaked in early 2020, there was a sharp decline in myocarditis admissions, probably attributed to profound disruptions in healthcare provision, but possibly due to reduced transmission of other viruses during lockdown. Whilst myocarditis admissions increased during the second lockdown, there was no clear association between COVID19 and myocarditis admission numbers. Further research may identify delayed presentations or sequelae of myocarditis, particularly following the larger COVID-19 peak in January 2021, as well as the impact of the vaccination programme.