Impaired myocardial perfusion and myocardial inflammation of acute myopericarditis associated with COVID-19

Myocarditis and pericarditis, or myopericarditis, is a rare, albeit life-threatening, cardiac complication of coronavirus disease 2019 (COVID-19). Although most patients recover from myocardial inflammation within weeks of the acute infection, there are concerns about acute and long-term myocardial injury. Coronary microvascular dysfunction and myocardial inflammation in the affected myocardium might be key factors in developing acute COVID-19-associated myopericarditis. In this case report, we describe a 38-year-old woman diagnosed with acute COVID-19-associated myopericarditis who was treated successfully. This case highlights the remarkable recovery in coronary microcirculation and myocardial inflammation assessed using multi-imaging modalities from the acute phase to 3-month follow-up using histopathological assessments.

Learning objective: Acute myopericarditis is one of the serious cardiac complications associated with severe acute respiratory syndrome coronavirus 2 infection, although an accurate diagnosis might be challenging. We emphasize a novel combination of magnetic resonance imaging and positron emission tomography focusing on serial changes in coronary microcirculation and myocardial inflammation from acute to recovery phases. Our findings may elucidate the pathophysiology of this entity at the micro and macro levels.