Myocarditis following COVID-19 vaccination: magnetic resonance imaging study

Shiyovich, Arthur; Witberg, Guy; Aviv, Yaron; Eisen, Alon; Orvin, Katia; Wiessman, Maya; Grinberg, Tzlil; Porter, Avital; Kornowski, Ran; Hamdan, Ashraf

doi:10.1093/ehjci/jeab230

Cited by 33 publications

(41 citation statements)

References 15 publications

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“…However, it should be mentioned that one of the patients (25%) was a 44-yearold woman, which could imply less dominance of men with myocarditis following the 3rd vaccine, yet this is a small cohort thus such inferences are significantly limited. The CMR findings are overall mild, with two patients having ∼1% LGE, and consistent with those previously reported following the first two doses of the vaccine (5)(6)(7)(8). Although this could partially result from the delayed scan, it is probably consistent with the favorable outcome of these patients.…”

Section: Discussionsupporting

confidence: 88%

“…Incidence of such post-vaccine myocarditis was reported to be highest among younger males, with most cases being mild or moderate with favorable clinical outcomes (1,4). As reported by us (5) and others (6)(7)(8), cardiovascular magnetic resonance (CMR) imaging findings of these patients were consistently mild and in line with "classical myocarditis." Following the resurgence of COVID-19 morbidity, the Israeli Ministry of Health announced a campaign to administer the third dose (i.e., booster) of the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) to individuals who received the second dose > 5 months earlier, starting on July 13 (9).…”

Section: Introductionmentioning

confidence: 53%

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A Case Series of Myocarditis Following Third (Booster) Dose of COVID-19 Vaccination: Magnetic Resonance Imaging Study

Shiyovich

Witberg

Aviv

et al. 2022

Front. Cardiovasc. Med.

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BackgroundMyocarditis has been reported following the first two doses of Pfizer-BNT162b2 messenger RNA (mRNA) COVID-19 vaccination. Administration of a third dose (booster) of the vaccine was initiated recently in Israel.ObjectiveThe aim of this study was to describe the characteristics of patients referred for cardiac magnetic resonance (CMR) imaging with myocarditis following the booster.MethodsPatients referred for CMR imaging with a clinical diagnosis of myocarditis within 21 days following the booster, between July 13 and November 11, 2021, were analyzed.ResultsOverall, 4 patients were included, 3/4 (75%) were men, and the mean age was 27 ± 10 years. The time from booster administration to the onset of symptoms was 5.75 ± 4.8 days (range 2–14). Obstructive coronary artery disease was excluded in 3 of the patients (75%). CMR was performed 34 ± 15 days (range 8-47 days) following the 3rd vaccination. The mean left ventricular ejection fraction was 61 ± 7% (range 53–71%), and regional wall motion abnormalities were present in one of the patients. Global T1 was increased in one of the patients, while focal T1 values were increased in 3 of the patients. Global T2 was increased in one of the patients, while focal T2 values were increased in all the patients. Global ECV was increased in 3 of the patients, while focal ECV was increased in all the patients. Median late gadolinium enhancement (LGE) was 4 ± 3% (range 1–9%), with the inferolateral segment as the most common location (3 of the 4 patients). All the patients met the Updated Lake Louise Criteria.ConclusionsPatient characteristics and CMR imaging findings of myocarditis following the administration of the booster vaccine are relatively mild and consistent with those observed with the first two doses. Although larger-scale prospective studies are necessary, these initial findings are somewhat reassuring.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 53%

A Case Series of Myocarditis Following Third (Booster) Dose of COVID-19 Vaccination: Magnetic Resonance Imaging Study

Shiyovich

Witberg

Aviv

et al. 2022

Front. Cardiovasc. Med.

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“…Several studies (35)(36)(37)(38)(39) agree on the fact that acute myocarditis or myocarditis-like traits are present after anti-SARS-CoV2 vaccination in a minority of subjects with CMR findings similar to those observed in patients with COVID-19. However, the mechanisms of these change as the mechanisms of post-COVID-19 myocardial modification remain largely unknown.…”

Section: Discussionmentioning

confidence: 69%

COVID-19 vs. Classical Myocarditis Associated Myocardial Injury Evaluated by Cardiac Magnetic Resonance and Endomyocardial Biopsy

Tanacli

Doeblin

Götze

et al. 2021

Front. Cardiovasc. Med.

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Background: Despite the ongoing global pandemic, the impact of COVID-19 on cardiac structure and function is still not completely understood. Myocarditis is a rare but potentially serious complication of other viral infections with variable recovery, and is, in some cases, associated with long-term cardiac remodeling and functional impairment.Aim: To assess myocardial injury in patients who recently recovered from an acute SARS-CoV-2 infection with advanced cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB).Methods: In total, 32 patients with persistent cardiac symptoms after a COVID-19 infection, 22 patients with acute classic myocarditis not related to COVID-19, and 16 healthy volunteers were included in this study and underwent a comprehensive baseline CMR scan. Of these, 10 patients post COVID-19 and 13 with non-COVID-19 myocarditis underwent a follow-up scan. In 10 of the post-COVID-19 and 15 of the non-COVID-19 patients with myocarditis endomyocardial biopsy (EMB) with histological, immunohistological, and molecular analysis was performed.Results: In total, 10 (31%) patients with COVID-19 showed evidence of myocardial injury, eight (25%) presented with myocardial oedema, eight (25%) exhibited global or regional systolic left ventricular (LV) dysfunction, and nine (28%) exhibited impaired right ventricular (RV) function. However, only three (9%) of COVID-19 patients fulfilled updated CMR–Lake Louise criteria (LLC) for acute myocarditis. Regarding EMB, none of the COVID-19 patients but 87% of the non-COVID-19 patients with myocarditis presented histological findings in keeping with acute or chronic inflammation. COVID-19 patients with severe disease on the WHO scale presented with reduced biventricular longitudinal function, increased RV mass, and longer native T1 times compared with those with only mild or moderate disease.Conclusions: In our cohort, CMR and EMB findings revealed that SARS-CoV-2 infection was associated with relatively mild but variable cardiac involvement. More symptomatic COVID-19 patients and those with higher clinical care demands were more likely to exhibit chronic inflammation and impaired cardiac function compared to patients with milder forms of the disease.

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“…In a series of 15 male patients with clinically adjudicated myocarditis within 42 days of first-Comirnaty vaccination who underwent CMRI, imaging findings were consistent with ‘classical myocarditis’ 32. LGE was found among 13/15 patients with a median of 2% (range 0%–15%), with inferolateral wall being the most common location (8/13).…”

Section: Introductionmentioning

confidence: 87%

“…31 In a series of 15 male patients with clinically adjudicated myocarditis within 42 days of first-Comirnaty vaccination who underwent CMRI, imaging findings were consistent with 'classical myocarditis'. 32 LGE was found among 13/15 patients with a median of 2% (range 0%-15%), with inferolateral wall being the most common location (8/13). The patterns of the LGE were: mid-wall in six patients; epicardial in five patients; and mid-wall and Cardiac risk factors and prevention epicardial in two patients.…”

Section: Covid-19 Postvaccination Myocarditismentioning

confidence: 99%

Acute myocarditis caused by COVID-19 disease and following COVID-19 vaccination

Kornowski

Witberg

2022

Open Heart

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Myocarditis and pericarditis are inflammatory conditions of the heart that present a range of symptoms, often including chest pain, fatigue, breathlessness and palpitations that may be irregular due to cardiac rhythm disturbances. Myocarditis has been proposed to account for a fraction of cardiac injury among patients infected with SARS-CoV-2 and associated systemic inflammation; and it might be one of the reasons for the high mortality seen in COVID-19 patients. Furthermore, following vaccination with mRNA COVID-19 vaccines (ie, Comirnaty and Spikevax), myocarditis and pericarditis can develop within a few days of vaccination, particularly following the second dose. Based on recent reviewed data, the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have determined that the risk for both of these conditions is overall ‘very rare’ (~1 in 10 000 vaccinated people may be clinically affected), with the highest risk among younger males. Both EMA and FDA agree that the benefits of all authorised COVID-19 vaccines continue to outweigh their risks, given the threat of serious COVID-19 illness and related complications. Since myocarditis has a very wide clinical spectrum, ranging from mild to fulminant life-threatening disease, we present in this review a sum of the latest findings and considerations for the proper diagnosis and management of affected patients.

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Myocarditis following COVID-19 vaccination: magnetic resonance imaging study

Cited by 33 publications

References 15 publications

A Case Series of Myocarditis Following Third (Booster) Dose of COVID-19 Vaccination: Magnetic Resonance Imaging Study

A Case Series of Myocarditis Following Third (Booster) Dose of COVID-19 Vaccination: Magnetic Resonance Imaging Study

COVID-19 vs. Classical Myocarditis Associated Myocardial Injury Evaluated by Cardiac Magnetic Resonance and Endomyocardial Biopsy

Acute myocarditis caused by COVID-19 disease and following COVID-19 vaccination

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