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Плеврит и перикардит как причина атипичной боли в грудной клетке у пациентов в раннем периоде после COVID-19

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Во время пандемии на приеме кардиолога возросло количество пациентов с неангинальной болью в грудной клетке. Цель исследования: оценить встречаемость признаков плеврита и перикардита после COVID-19 у некоморбидных пациентов с атипичной болью в грудной клетке и описать их характеристики по данным эхокардиографии и магнитно-резонансной томографии. Материал и методы. С февраля 2021 г. по январь 2022 г. в исследование проспективно последовательно включено 200 пациентов, амбулаторно обратившихся к кардиологу с дискомфортом в области сердца, впервые возникшим после перенесенной новой коронавирусной инфекции. Критерии включения: 18-50 лет, 5-12 нед после заражения SARS-CoV-2, неангинозный характер боли в грудной клетке. Критерии исключения: пневмония или признаки тромбоэмболии ветвей легочной артерии, коронарная болезнь сердца, застойная сердечная или почечная недостаточность, онкопатология, химиотерапия, лучевая терапия органов грудной клетки в анамнезе. Проводился опрос (да/нет) на наличие общего недомогания, ухудшения качества жизни, гипертермии, кашля. Ультразвуковое исследование перикарда и плевры на выявление выпота или поствоспалительных изменений выполнялось в соответствии с рекомендациями. При плохой ультразвуковой визуализации или отсутствии признаков поражения перикарда или плевры у пациентов с типичными симптомами проводилась магнитно-резонансная томография. Результаты. В исследование включено 82 женщины и 118 мужчин 39 (28-46) лет. С учетом клиники перикардит диагностирован у 152 (76%) пациентов, из них выпотной перикардит - у 119 (78%), миокардит - у 6 (3%) и миоперикардит - у 49 (25%) пациентов, плеврит выявлен у 22 (11%) пациентов, экссудативный плеврит - у 11 (5,5%) с преимущественным односторонним поражением прилежащей к сердцу медиастинально-диафрагмальной области. Гипертермия регистрировалась в 2,5% случаев, общее недомогание и снижение качества жизни отмечали 60 и 84% пациентов. Выводы. Воспаление серозных оболочек как причина атипичной боли в грудной клетке среди молодых некоморбидных пациентов в раннем периоде после COVID-19 выявлено у 87% пациентов. В ближайшие годы, вероятно, стоит проводить ультразвуковое исследование перикарда и плевры всем пациентам с болью в грудной клетке.

Ключевые слова:
COVID-19, перикардит, плеврит, серозит, эхокардиография, COVID-19, pericarditis, pleurisy, serositis, echocardiography

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Pleurisy and pericarditis as a cause of atypical chest pain in patients with in early post-COVID-19 period

During the pandemic COVID-19, there has been an increase in the number of patients with non-anginal chest pain at cardiologist appointments. Objective. To assess the incidence of signs of pleurisy and pericarditis after COVID-19 in non-comorbid patients with atypical chest pain and describe their characteristics according to echocardiography and magnetic resonance imaging. Materials and methods. From February 2021 to January 2022, 200 outpatients were prospectively enrolled in the study, all of them suffered from a discomfort in the heart region for the first time after SARS-CoV-2 infection. Inclusion criteria: 18-50 years old, 5-12 weeks after SARS-CoV-2 infection, non-anginal chest pain. Exclusion criteria: pneumonia or signs of pulmonary thromboembolism, coronary heart disease, congestive heart failure or kidney disease, clinical or laboratory signs of myocarditis, oncopathology, radiation or chemotherapy of the chest in past medical history. A survey was conducted (yes/no) for the presence of general malaise, quality of life deterioration, hyperthermia, cough. Ultrasound examination of the pericardium and pleura to detect effusion or postinflammatory changes was performed in accordance with the recommendations. Magnetic resonance imaging was performed if ultrasound imaging was poor or there was no evidence of pericardial or pleural involvement in patients with typical symptoms. Results. 82 women and 118 men were included. Median of age 39 [28-46] years old. Pericarditis was diagnosed in 152 (76%) patients, including effusive pericarditis in 119 (78%), myocarditis in 6 (3%) and myopericarditis in 49 (25%) patients, pleurisy was detected in 22 (11%) patients, exudative pleurisy - in 11 (5.5%) patients with a predominant unilateral lesion of the mediastinal-diaphragmatic region adjacent to the heart. Hyperthermia was recorded in 2.5% of cases, general malaise - in 60% and a decrease in the quality of life - in 84%. Conclusion. Serositis as a cause of atypical chest pain among young non-comorbid patients in early post- COVID was identified in 87% of patients. In the coming years, it is probably worthwhile to perform ultrasound of the pericardium and pleura in all patients with chest pain.

Keywords:
COVID-19, перикардит, плеврит, серозит, эхокардиография, COVID-19, pericarditis, pleurisy, serositis, echocardiography