Cardiac magnetic resonance characteristics of acute myocarditis occurring after mRNA-based COVID-19 vaccines immunization

Meyer-Szary, Jarosław; Bazgier, Magdalena; Lubocka, Paulina; Dorniak, Karolina; Sabiniewicz, Robert

doi:10.5603/cj.a2021.0152

Cited by 9 publications

(15 citation statements)

References 10 publications

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“…Overall, 266 publications were retrieved for review of full‐text articles. Finally, 102 publications, including 56 case reports 12–50,52–58,92–94,97,98,101,102,105,106 and 46 case series 5,7,10,23,35,45,51,59–91,95,96,100,103,104,107 fulfilled the inclusion criteria. Figure 1 shows the selection process in detail.…”

Section: Resultsmentioning

confidence: 99%

Cardiac MRI Findings in COVID‐19 Vaccine‐Related Myocarditis: A Pooled Analysis of 468 Patients

Samimisedeh

Afshar

Hassani

et al. 2022

Magnetic Resonance Imaging

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Understanding the pattern and severity of myocarditis caused by the coronavirus disease 2019 (COVID‐19) vaccine is imperative for improving the care of the patients, and cardiac evaluation by MRI plays a key role in this regard. Our systematic review and meta‐analysis aimed to summarize cardiac MRI findings in COVID‐19 vaccine‐related myocarditis. We performed a comprehensive systematic review of literature in PubMed, Scopus, and Google Scholar databases using key terms covering COVID‐19 vaccine, myocarditis, and cardiac MRI. Individual‐level patient data (IPD) and aggregated‐level data (AD) studies were pooled through a two‐stage analysis method. For this purpose, all IPD were first gathered into a single data set and reduced to AD, and then this AD (from IPD studies) was pooled with existing AD (from the AD studies) using fixed/random effect models. I 2 was used to assess the degree of heterogeneity, and the prespecified level of statistical significance ( P value for heterogeneity) was <0.1. Based on meta‐analysis of 102 studies ( n = 468 patients), 79% (95% confidence interval [CI]: 54%–97%) of patients fulfilled Lake Louise criteria (LLC) for diagnosis of myocarditis. Cardiac MRI abnormalities included elevated T2 in 72% (95% CI: 50%–90%), myocardial late gadolinium enhancement (LGE) in 93% (95% CI: 83%–99%; nearly all with a subepicardial and/or midwall pattern), impaired left ventricular ejection fraction (LVEF) (<50%) in 4% (95% CI: 1.0%–9.0%). Moreover, elevated T1 and extracellular volume fraction (ECV) (>30), reported only by some IPD studies, were detected in 74.5% (76/102) and 32% (16/50) of patients, respectively. In conclusion, our findings may suggest that over two‐thirds of patients with clinically suspected myocarditis following COVID‐19 vaccination meet the LLC. COVID‐19 vaccine‐associated myocarditis may show a similar pattern compared to other acute myocarditis entities. Notably, preserved LVEF is probably a common finding in these patients. Evidence Level 4 Technical Efficacy Stage 3

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Section: Resultsmentioning

confidence: 99%

Cardiac MRI Findings in COVID‐19 Vaccine‐Related Myocarditis: A Pooled Analysis of 468 Patients

Samimisedeh

Afshar

Hassani

et al. 2022

Magnetic Resonance Imaging

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“…In particular, we included the following: 7 paediatric case reports, 13 , 14 , 15 , 16 , 17 , 18 , 19 6 paediatric case series, 20 , 21 , 22 , 23 , 24 , 25 6 mixed case series, including both adolescent and adult patients in which we collected only cases ≤18 years. 26 , 27 , 28 , 29 , 30 , 31 Analysing all these reports, we summarised cases of hospitalised myocarditis following COVID‐19 vaccination among adolescents. We reported fifty‐seven cases with age range from 12 to 18 years, of which fifty‐five (96.5%) were boys, only two girls.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 27 studies included in our systematic review, 8 were observational studies while 19 were case reports and case series. In particular, we included the following: 7 paediatric case reports, 13–19 6 paediatric case series, 20–25 6 mixed case series, including both adolescent and adult patients in which we collected only cases ≤18 years 26–31 . Analysing all these reports, we summarised cases of hospitalised myocarditis following COVID‐19 vaccination among adolescents.…”

Section: Resultsmentioning

confidence: 99%

COVID‐19 review shows that benefits of vaccinating children and adolescents appear to outweigh risks of post‐vaccination myopericarditis

et al. 2022

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Aim Myopericarditis after COVID‐19 vaccination were the most serious adverse events reported in children over 5 years of age. We want to summarise these cases, describing their incidence, clinical features, diagnostic pathways, therapeutic strategies and outcome. Methods A systematic review of the literature was conducted until 20 March 2022 by bibliographic electronic databases. We included all reports of post‐vaccination myopericarditis in children aged between 5 and 18 years. Results All reported cases had elevated serum Troponin levels, associated with electrocardiogram changes, but often with normal echocardiogram. Cardiac magnetic resonance images always showed typical alterations. The pathogenetic mechanism is still unknown. Myocarditis following post‐COVID vaccination is more frequent in boys with an average age of about 15 years. Treatment involves the usage of non‐steroidal anti‐inflammatory drugs, and the average hospitalisation is about 3 days. The long‐term consequences are not yet known, so these patients should be studied in a cardiological follow‐up and abstention from physical activity should be recommended. Conclusion The benefits of COVID‐19 vaccination in children and adolescents appear to outweigh the risk of developing post‐vaccination myopericarditis. We can also speculate a possible approval of vaccination in children under 5 years for the coming winter.

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“…The initial search yielded 268 potentially relevant articles from which 75 unique studies involving 188 patients met eligibility criteria [ 16 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ,…”

Section: Resultsmentioning

confidence: 99%

Clinical Characteristics of Patients with Myocarditis following COVID-19 mRNA Vaccination: A Systematic Review and Meta-Analysis

Matar

Mansour

Nakanishi

et al. 2022

JCM

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COVID-19 mRNA vaccinations have recently been implicated in causing myocarditis. Therefore, the primary aim of this systematic review and meta-analysis was to investigate the clinical characteristics of patients with myocarditis following mRNA vaccination. The secondary aims were to report common imaging and laboratory findings, as well as treatment regimes, in these patients. A literature search was performed from December 2019 to June 2022. Eligible studies reported patients older than 18 years vaccinated with mRNA, a diagnosis of myocarditis, and subsequent outcomes. Pooled mean or proportion were analyzed using a random-effects model. Seventy-five unique studies (patient n = 188, 89.4% male, mean age 18–67 years) were included. Eighty-six patients had Moderna vaccines while one hundred and two patients had Pfizer-BioNTech vaccines. The most common presenting symptoms were chest pain (34.5%), fever (17.1%), myalgia (12.4%), and chills (12.1%). The most common radiologic findings were ST-related changes on an electrocardiogram (58.7%) and hypokinesia on cardiac magnetic resonance imaging or echocardiography (50.7%). Laboratory findings included elevated Troponin I levels (81.7%) and elevated C-reactive protein (71.5%). Seven patients were admitted to the intensive care unit. The most common treatment modality was non-steroid anti-inflammatory drugs (36.6%) followed by colchicine (28.5%). This meta-analysis presents novel evidence to suggest possible myocarditis post mRNA vaccination in certain individuals, especially young male patients. Clinical practice must therefore take appropriate pre-cautionary measures when administrating COVID-19 mRNA vaccinations.

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Cardiac magnetic resonance characteristics of acute myocarditis occurring after mRNA-based COVID-19 vaccines immunization

Cited by 9 publications

References 10 publications

Cardiac MRI Findings in COVID‐19 Vaccine‐Related Myocarditis: A Pooled Analysis of 468 Patients

Cardiac MRI Findings in COVID‐19 Vaccine‐Related Myocarditis: A Pooled Analysis of 468 Patients

COVID‐19 review shows that benefits of vaccinating children and adolescents appear to outweigh risks of post‐vaccination myopericarditis

Clinical Characteristics of Patients with Myocarditis following COVID-19 mRNA Vaccination: A Systematic Review and Meta-Analysis

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