As of September 18th, 2021, global casualties due to COVID-19 infections approach 200 million, several COVID-19 vaccines have been authorized to prevent COVID-19 infection and help mitigate the spread of the virus. Despite the vast majority having safely received vaccination against SARS-COV-2, the rare complications following COVID-19 vaccination have often been life-threatening or fatal. The mechanisms underlying (multi) organ complications are associated with COVID-19, either through direct viral damage or from host immune response (i.e., cytokine storm). The purpose of this manuscript is to review the role of imaging in identifying and elucidating multiorgan complications following SARS-COV-2 vaccination—making clear that, in any case, they represent a minute fraction of those in the general population who have been vaccinated. The authors are both staunch supporters of COVID-19 vaccination and vaccinated themselves as well.

To evaluate clinical and cardiac magnetic resonance (CMR) short-term follow-up (FU) in patients with vaccine-associated myocarditis, pericarditis or myo-pericarditis (VAMP) following COVID-19 vaccination. We retrospectively analyzed 44 patients (2 women, mean age: 31.7 ± 15.1 years) with clinical and CMR manifestations of VAMP, recruited from 13 large tertiary national centers. Inclusion criteria were troponin raise, interval between the last vaccination dose and onset of symptoms < 25 days and symptoms-to-CMR < 20 days. 29/44 patients underwent a short-term FU-CMR with a median time of 3.3 months. Ventricular volumes and CMR findings of cardiac injury were collected in all exams. Mean interval between the last vaccination dose and the onset of symptoms was 6.2 ± 5.6 days. 30/44 patients received a vaccination with Comirnaty, 12/44 with Spikevax, 1/44 with Vaxzevria and 1/44 with Janssen (18 after the first dose of vaccine, 20 after the second and 6 after the “booster” dose). Chest pain was the most frequent symptom (41/44), followed by fever (29/44), myalgia (17/44), dyspnea (13/44) and palpitations (11/44). At baseline, left ventricular ejection fraction (LV-EF) was reduced in 7 patients; wall motion abnormalities have been detected in 10. Myocardial edema was found in 35 (79.5%) and LGE in 40 (90.9%) patients. Clinical FU revealed symptoms persistence in 8/44 patients. At FU-CMR, LV-EF was reduced only in 2 patients, myocardial edema was present in 8/29 patients and LGE in 26/29. VAMPs appear to have a mild clinical presentation, with self-limiting course and resolution of CMR signs of active inflammation at short-term follow-up in most of the cases.

Funding Acknowledgements Type of funding sources: None. Introduction Data supporting the role of stress test myocardial perfusion imaging (MPI) before non-cardiac surgery (NCS) are sparse and out of date. In particular, there is no specific evidence on the use of stress cardiac magnetic resonance (sCMR) in this setting. The aim of the present study was to evaluate the impact MPI stress test with sCMR and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) on surgery-related cardiac events. Method In this single-centre retrospective study, we included all patients with CAD or at least two cardiovascular risk factors undergoing intermediate-to-high-risk non-cardiac surgery. After a pre-operative cardiological assessment, including EKG and echocardiography, the indication to perform a pre-operative MPI-stress-test relied on the clinical judgement of the cardiologist. Cardiac events occurring within 30 days from surgery were evaluated. A composite primary endpoint included myocardial infarction, unstable angina, cardiac death, cardiogenic shock and pulmonary oedema. The secondary endpoint was the rate of acute coronary syndromes. Results A total of 1590 patients were included, of whom 669 underwent an MPI stress test strategy (287 sCMR, 382 SPECT-MPI). The rate of 30-day cardiac events was lower in the stress test group vs. the non-stress test group (1.2% vs 3.4%; p 0,006; figure 1). Adopting a stress test strategy showed a significant reduction of composite endpoint (OR: 0.334, IC: 0.155 – 0.766, p 0.009) and acute coronary syndrome (OR: 0.414, IC: 0.174 – 0.984, p 0.046) at multivariable analysis. Stress CMR was non-inferior to SPECT in predicting cardiac events and showed a greater accuracy to predict coronary artery revascularizations (AUC for sCMR: 0.95 with a percentage of myocardial ischemia cut-point of 5.5%; figure 2). Conclusions A stress-test strategy is associated with a lower incidence of cardiac events in high-risk patients candidate to intermediate-to-high-risk non-cardiac surgery. The rate of cardiac complications is similarly predicted by sCMR and SPECT-MPI, although sCMR is more accurate in predicting coronary artery revascularizations.

Aims Mitral annulus disjunction (MAD) has been associated with sudden cardiac death in selected patients with arrhythmic presentation, while its clinical significance in unselected cohorts remains unknown. Our purpose was to assess the prevalence and clinical significance of MAD in consecutive patients referred to cardiovascular-magnetic-resonance (CMR). Methods and results Our population included 103 consecutive patients undergoing CMR at our Institution, between August and September 2021. MAD was defined as a  ≥ 1 mm atrial displacement of the mitral leaflet hinge point in standard long-axis cine images during end-systole. MAD analysis was performed in 97 patients (feasibility = 94%) and resulted positive in 49 (51%). MAD—patients were more often males (75% vs. 57%; P = 0.045) and affected by ischaemic (35% vs. 12%, P = 0.01) and non-ischaemic cardiomyopathy (38% vs. 16%, P = 0.026) compared to MAD+ patients. No significant differences were found in terms of age, history of ventricular arrhythmias, bi-ventricular and bi-atrial volumes, bi-ventricular ejection fraction, native T1 and T2 mapping values, extracellular volume, and prevalence of late gadolinium enhancement (P &gt; 0.05 for all) between MAD + vs. MAD—patients. MAD extent was higher in patients with mitral valve prolapse (MVP; n = 7), (3.5 ± 1.5 mm in MVP+ vs. 2.0 ± 1.0 mm in MVP– patients; P = 0.004). No significant differences were conversely found in MAD extent between patients with and without ventricular arrhythmias (2.5 ± 1.1 mm vs. 2.3 ± 1.1 mm; P = 0.815). Conclusions Our findings suggest a high prevalence of MAD in unselected cohorts of patients, with no clinical significance. Prospective studies are needed to further elucidate the interplay between MAD and malignant ventricular arrhythmias in unselected cohorts of patients.