Cardiovascular magnetic resonance imaging patterns of acute COVID-19 mRNA vaccine-associated myocarditis in young male patients: A first single-center experience

Abstract

BackgroundThe risk of myocarditis after mRNA vaccination against COVID-19 has emerged recently. Current evidence suggests that young male patients are predominantly affected. In the majority of the cases, only mild symptoms were observed. However, little is known about cardiac magnetic resonance (CMR) imaging patterns in mRNA-related myocarditis and their differences when compared to classical viral myocarditis in the acute phase of inflammation.Methods and resultsIn total, 10 mRNA vaccination-associated patients with myocarditis were retrospectively enrolled in this study and compared to 10 patients suffering from viral myocarditis, who were matched for age, sex, comorbidities, and laboratory markers. All patients (n = 20) were hospitalized and underwent a standardized clinical examination, as well as an echocardiography and a CMR. Both, clinical and imaging findings and, in particular, functional and volumetric CMR assessments, as well as detailed tissue characterization using late gadolinium enhancement and T1 + T2-weighted sequences, were compared between both groups. The median age of the overall cohort was 26 years (group 1: 25.5; group 2: 27.5; p = 0.57). All patients described chest pain as the leading reason for their initial presentation. CMR volumetric and functional parameters did not differ significantly between both groups. In all cases, the lateral left ventricular wall showed late gadolinium enhancement without significant differences in terms of the localization or in-depth tissue characterization (late gadolinium enhancement [LGE] enlargement: group 1: 5.4%; group 2: 6.5%; p = 0.14; T2 global/maximum value: group 1: 38.9/52 ms; group 2: 37.8/54.5 ms; p = 0.79 and p = 0.80).ConclusionThis study yielded the first evidence that COVID-19 mRNA vaccine-associated myocarditis does not show specific CMR patterns during the very acute stage in the most affected patient group of young male patients. The observed imaging markers were closely related to regular viral myocarditis in our cohort. Additionally, we could not find any markers implying adverse outcomes in this relatively little number of patients; however, this has to be confirmed by future studies that will include larger sample sizes.

Cardiac magnetic resonance follow-up of COVID-19 vaccine associated acute myocarditis

“…Collaborating previously published findings, we found vaccine associated myocarditis to predominantly affect younger males (1,3,35). Typically, clinical course of disease is mild with rapid resolution of symptoms within a few months (17,19,25,28,33), although persistent LGE on CMR indicative of fibrous scar tissue was noted in all our patients. Resolution of other CMR findings (elevated T1 and T2 times, focal or diffuse edema) are to be expected as the extent of the inflammatory process diminishes over time.…”

“…The start of the coronavirus disease-19 (COVID- 19) outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019 prompted a world-wide effort to curtail the spread of the pandemic. One possible way to achieve this was the development of safe and effective vaccines.…”

Phenotyping myocardial injury related to COVID and SARS-CoV-2 vaccination: insights from cardiovascular magnetic resonance

“…There has been an extensive body of literature on CMR findings in all these syndromes that showed different patterns of myocardial pathology such as global myocardial edema, irreversible myocardial injury such as necrosis and scarring, as well as pericardial effusion. Several such studies have reported similarities of such patterns to those found in myocardial inflammation triggered by other viruses (4,5), albeit with some difference in some studies (6,7).…”