Coronavirus disease 2019 vaccination-related pericarditis: a single tertiary-center experience

Abstract

Aims Vaccination represents a cornerstone of prevention in the COVID-19 pandemic. Rare adverse events including acute pericarditis and myopericarditis have been reported.Methods All consecutive patients referred to our referral center for pericardial diseases following COVID-19 vaccination from 1 April 2021 to 15 April 2022 were included. Acute pericarditis and myopericarditis were diagnosed according to ESC guidelines. Patients with SARS-CoV-2 infection were excluded from the study.Results Twenty-four patients (79% men) aged 39.7 W 19.8 years were referred to our center with pericarditis after receiving COVID-19 vaccination. Thirteen (54%) patients were diagnosed with myopericarditis. The mean time between vaccination and symptoms onset was 7.0 W 4.9 days, and the most frequent symptom was pericarditic chest pain (83%). Respectively, 50 and 33% of patients presented after the second and the third dose of the vaccine. Almost all patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine. Five patients (21%) experienced a recurrence of pericarditis. No patient died or developed constrictive pericarditis. Mean follow-up was 8.0 W 3.2 months.Conclusion COVID-19 vaccine-related pericarditis typically manifest with mild clinical signs, in young male individuals, a few days after the second or third vaccine dose and are commonly characterized by a rapid complete recovery.

Filling the gap in epidemiology, management and clinical course of COVID-19 vaccination-related pericarditis

“…Although male predominance has been reported in postvaccine myocarditis (the mechanism of which is not fully elucidated), 13 data on sex in pericarditis are missing. In this perspective, the study by Collini et al 14 provides further insights into this field, in line with recent reports from AIFA 4 on similar frequency of postvaccine pericarditis in both sexes. Third, clinical presentation of postvaccine pericarditis was similar to that of forms unrelated to vaccination with chest pain as the predominant symptom (83% of cases) and typical findings on surface ECG such as widespread ST-segment elevation with PR depression, with a clinical onset at a median time of 7 days from vaccination.…”

“…Myopericarditis unrelated to vaccination has a long-term benign outcome, especially in the presence of preserved global longitudinal strain. [21][22][23] In this study, 14 most patients were only briefly admitted to hospital and responded well to standard therapy. Short-term clinical outcomes have been favourable, without relevant arrhythmias and with rapid complete recovery.…”

“…Considering the small sample size, fairly addressed in the limitations by the Authors, the study by Collini et al 14 reports several interesting findings. First, their results provided evidence that the relative incidence of (myo)pericarditis is highest among individuals younger than 40 years after a second or third dose.…”

“…20 In this study cohort, anti-inflammatory therapy was effective in controlling symptoms and treating postvaccine pericarditis with 92% of patients receiving one or two anti-inflammatory drugs, mostly ibuprofen. 14 In light of the predominant pericarditis component, patients with myopericarditis (presenting with systolic dysfunction in 30% of cases) were treated with colchicine, NSAIDs or corticosteroids as in acute pericarditis. Although potential concerns of toxicity have been raised in animal models of viral myocarditis treated with colchicine, no adverse drug-related effect occurred.…”

“…In the last issue of the Journal, Collini et al 14 provide real-world data of postvaccine pericarditis, with and without concomitant myocarditis (i.e. ‘myopericarditis’), defined according to the official recommendation by Italian and international health authorities 3,4 .…”