Keywords
We thank Lampejo and Durkin for their interest in our recent publication, Myocarditis and Cardiac Complications Associated With COVID-19 and mRNA Vaccination: A Pragmatic Narrative Review to Guide Clinical Practice [
[1]
], and for their letter regarding the use of non-steroidal anti-inflammatory drugs (NSAIDs) in these clinical settings.The management of COVID-19 and the complications of specific organ involvement is a rapidly expanding area of medicine, and there are limited data on the treatment of COVID-19 and mRNA vaccination-related myocarditis. In general, the use of NSAIDs in myocarditis is not recommended [
[2]
], based on experimental data from seminal animal studies indicating possible harm in viral aetiologies of myocarditis. Furthermore, NSAIDs are generally discouraged in acute or chronic cases of heart failure [- Caforio A.L.
- Pankuweit S.
- Arbustini E.
- Basso C.
- Gimeno-Blanes J.
- Felix S.B.
- et al.
Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.
Eur Heart J. 2013; 34 (48a-48d): 2636-2648
[3]
]. Though widely used in cases of isolated pericarditis, human safety data of NSAIDs in myocarditis and myopericarditis is limited to small retrospective audits [- Atherton J.J.
- Sindone A.
- De Pasquale C.G.
- Driscoll A.
- MacDonald P.S.
- Hopper I.
- et al.
National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018.
Heart Lung Circ. 2018; 27: 1123-1208
[4]
,[5]
], and robust data related specifically to COVID-19 is absent. Importantly, NSAIDs remain first-line therapy in pericarditis [[6]
]. However, we agree with Lampejo and Durkin that, consistent with guideline recommendations for myocarditis and pericarditis [- Adler Y.
- Charron P.
- Imazio M.
- Badano L.
- Barón-Esquivias G.
- Bogaert J.
- et al.
2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS).
Eur Heart J. 2015; 36: 2921-2964
[2]
,- Caforio A.L.
- Pankuweit S.
- Arbustini E.
- Basso C.
- Gimeno-Blanes J.
- Felix S.B.
- et al.
Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.
Eur Heart J. 2013; 34 (48a-48d): 2636-2648
[6]
], the use of NSAIDs should be carefully considered in cases related to COVID-19 or presentation associated with mRNA vaccination.- Adler Y.
- Charron P.
- Imazio M.
- Badano L.
- Barón-Esquivias G.
- Bogaert J.
- et al.
2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS).
Eur Heart J. 2015; 36: 2921-2964
References
- Myocarditis and cardiac complications associated with COVID-19 and mRNA vaccination: a pragmatic narrative review to guide clinical practice.Heart Lung Circ. 2022; 31: 924-933
- Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.Eur Heart J. 2013; 34 (48a-48d): 2636-2648
- National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018.Heart Lung Circ. 2018; 27: 1123-1208
- Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) does not affect outcome in patients with acute myocarditis or myopericarditis.J Cardiovasc Dev Dis. 2022; 9: 32
- Non-steroidal anti-inflammatory drug use in acute myopericarditis: 12-month clinical follow-up.Open Heart. 2019; 6e000990
- 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2015; 36: 2921-2964
Article info
Publication history
Published online: August 03, 2022
Identification
Copyright
© 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
ScienceDirect
Access this article on ScienceDirectLinked Article
- Myocarditis and Cardiac Complications Associated With COVID-19 and mRNA Vaccination: A Pragmatic Narrative Review to Guide Clinical PracticeHeart, Lung and CirculationVol. 31Issue 7
- PreviewCoronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus is likely to remain endemic globally despite widespread vaccination. There is increasing concern for myocardial involvement and ensuing cardiac complications due to COVID-19, however, the available evidence suggests these risks are low. Pandemic publishing has resulted in rapid manuscript availability though pre-print servers. Subsequent article retractions, a lack of standardised definitions, over-reliance on isolated troponin elevation and the heterogeneity of studied patient groups (i.e.
- Full-Text
- Preview
- Letter to the Editor Regarding: “Myocarditis and Cardiac Complications Associated With COVID-19 and mRNA Vaccination” by Holland et al., Heart Lung Circ. 2022;31(7):924-33.Heart, Lung and CirculationVol. 31Issue 10
- PreviewWe read with interest the article by Holland and colleagues who provide an extensive review and summary of the literature relating to COVID-19 and mRNA vaccine associated myocarditis [1], conditions for which clinical guidance has been lacking. The authors discuss in their article that there is insufficient evidence to recommend antiviral or immunomodulatory therapy (with the exception of significant respiratory involvement for which steroids may be beneficial); however, discussion surrounding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in COVID-19 and/or mRNA vaccine associated myocarditis is absent.
- Full-Text
- Preview
