Global Reports of Myocarditis Following COVID-19 Vaccination: A Systematic Review and Meta-Analysis

Abstract

In December 2020, the FDA granted emergency approval to Pfizer-BioNTech (BNT162b2) and Moderna (mRNA-1273) COVID-19 vaccines. There have been recent media reports of myocarditis after receiving COVID-19 vaccines, particularly the messenger RNA (mRNA) vaccines, causing public concern. This review summarizes information from published case series and case reports, with a strong emphasis on reporting patient and disease characteristics, investigation, and clinical outcome, to provide a comprehensive picture of the condition. Forty studies, including 147 cases, participated in this systematic review. The median age was 28.9 years; 93.9% were male and 6.1% were female. 72.1% of patients received the Pfizer-BioNTech (BNT162b2) vaccine, 24.5% of patients received the Moderna COVID-19 Vaccine (mRNA-1273), and the rest of the 3.3% received other types of vaccines. Furthermore, most myocarditis cases (87.1%) occurred after the second vaccine dose, after a median time interval of 3.3 days. The most frequently reported symptoms were chest pain, myalgia/body aches and fever. Troponin levels were consistently elevated in 98.6%. The admission ECG was abnormal in 88.5% of cases, and the left LVEF was lower than 50% in 26.5% of cases. The vast majority of patients (93.2%) resolved symptoms and recovered, and only 3 patients died. These findings may help public health policy to consider myocarditis in the context of the benefits of COVID-19 vaccination as well as to assess the cardiac condition before the choice of vaccine, which is offered to male adults. In addition, it must be carefully weighed against the very substantial benefit of vaccination.

Myocarditis after BNT162b2 and mRNA-1273 COVID-19 vaccination: A report of 7 cases

“…The troponin levels were elevated in all patients. In accordance with the current literature, post-vaccination myocarditis appears to be more common in younger men under the age of 30 years, and it appears to occur more frequently after the second dose of the COVID-19 mRNA vaccines, which occurs typically within 3–5 days after vaccination [ 3 , [9] , [10] , [11] ]. The precise mechanism of myocarditis after COVID-19 vaccines remains unknown to date.…”

Global reports of takotsubo (stress) cardiomyopathy following COVID-19 vaccination: A systematic review and meta-analysis

“…The females have noted a higher prevalence of these systematic effects [45] . Moreover, severe side effects have been reported and are under current monitoring: thrombocytopenic thrombosis, anaphylaxis, Bell's palsy, myocarditis, and capillary leak syndrome [46] , [57] , [66] .…”

Global reports of takotsubo (stress) cardiomyopathy following COVID-19 vaccination: a systematic review and meta-analysis

“…The females have noted a higher prevalence of these systematic effects [45]. Moreover, severe side effects have been reported and are under current monitoring: thrombocytopenic thrombosis, anaphylaxis, Bell’s palsy, myocarditis, and capillary leak syndrome [46,58,68].…”