Thread by @anish_koka

Important to put COVID - cardiac apocalypse papers in context.

Reports of Sars-COV2 and & cardiac proclivity have proliferated since early 2020.

Here is @JAMACardio saying that "78% of sur-
vivors had lingering heart disease, of which 60% had myocarditis"

Here's a frequently cited preprint studying health care workers that suggested rates of myocarditis, myopericarditis, and pericarditis at 26%, 11%, and 4% respectively long after sars-cov2 recovery.

But these studies relied heavily on abnormal cardiac MRIs only to make the diagnosis of myocarditis. The healthcare worker study only had 1 patient that leaked cardiac enzymes, & half had NO symptoms. Prior to 2020 you needed clinical criteria AND abnormal imaging.

The gold standard for a diagnosis of myocarditis is a cardiac biopsy demonstrating myocardial cell necrosis with adjacent inflammatory infiltrates. Cardiac MRI may be used as a surrogate, IF the clinical finding are supportive.

A review of all Sars-COV2 autopsy studies to date provides one way of validating the high prevalence reported by the MRI studies.

This study reviewed all autopsy studies (277 autopsies) sciencedirect.com/science/articl…

In the sickest of sick patients, the number isn't close to 60%.. Myocarditis was only reported in 7.2% of cases. And even this is likely an overcount.

"There were 20 reports of myocarditis in this cohort. However, the evidence supporting 16 of these are questionable. If those cases were reported as nonspecific inflammatory infiltrates, the in-
cidence of myocarditis falls to 1.4%."

"Even among these remaining 4, it is not clear from the manuscripts that COVID-19 myocarditis was determined as the cause of death"

"The SARS pandemic (>8,000 infected) caused no known myocarditis & the MERS epidemic (>2,000) caused only a single MRI-diagnosed case of myocarditis "

" It will be incumbent on our colleagues in radiology to better interpret the meaning of cardiac MRI changes and other study data in light of this low incidence of histopathologic myocarditis "

There may be other mechanisms for cardiac injury mediated by Sars-COV2, but this would involve an indirect mechanism that, so far, has not been seen in any significant rate related to any other viruses.

I think it frankly irresponsible for doctors to leap to assume some never-before-described novel mechanism of action which will result in some tsunami of future cardiac cases.. based on MRI studies and data mining expeditions using claims data to diagnose myocarditis

Just to provide a contrast to a mrna vaccine myocarditis report..