Recent Developments in the Pathogenesis of COVID-19-associated Myocarditis

Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)was initially thought to mainly affect the respiratory system. A growing body of research has found that SARS-CoV-2 infection can affect multiple human organ systems, and heart is a major target organ secondary to lung. COVID-19-associated cardiac injury is often seen clinically, about 1%-7% of which is myocarditis. COVID-19-associated myocarditis often has a poor outcome. However, the possible pathogenesis mechanisms of COVID-19-associated cardiac injury, and its progression to COVID-19-associated myocarditis, as well as related pathophysiological changes are still unknown. Available data analysis has revealed that the recognized mechanism of cardiac injury in COVID-19 is ACE2-mediated cardiac injury, and cytokine storm-mediated or immune-mediated cardiac injury is only suggestive currently. Due to limited use of cardiac MRI and endocardial biopsy as well as insufficient autopsy findings and other basic research data in patients with COVID-19-associated myocarditis, the diagnosis and treatment of COVID-19-associated myocarditis are challenges that still exist for clinicians. We reviewed the possible pathophysiological mechanisms of COVID-19-associated myocarditis, which will contribute to improving medical workers' understanding of this disease so that its related mortality may be reduced. Copyright © 2021 by the Chinese General Practice.