Myopericarditis after Covid-19 Vaccination – a Case Series

Pareek, Manan; Asnes, Jeremy; Baldassarre, Lauren A.; Casale, L.; Desai, Nihar; Elder, Robert W.; Faherty, Erin; Ferguson, Ian; Fishman, Robert F.; Ghazizadeh, Zaniar; Glick, Laura; Hall, Kevin D.; Khera, Rohan; Kokkinidis, Damianos G.; Kwan, Jennifer M.; O’Marr, Jamieson; Schussheim, Adam E.; Steele, Jeremy; Tuohy, Edward; Wang, Yanting; Spatz, Erica S.; Jacoby, Daniel; Miller, Edward J.

doi:10.2139/ssrn.3874571

Cited by 4 publications

(5 citation statements)

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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%

“…A total of 468 patients with suspected myocarditis and cardiac MRI findings were included in this study ( n = 294 from case reports/case series with IPD 5,7,9,11–66,68,70–73,75–87,89,91–95,97–107 and n = 174 from five case series 67,69,74,88,90 with AD). Based on data provided by 100 out of 102 studies, all included patients met CDC criteria for suspected myocarditis.…”

Section: Resultsmentioning

confidence: 99%

“…Timely diagnosis and management are crucial for improving the prognosis of this complication 5 . An increasing number of studies have utilized cardiac MRI, as the most important noninvasive diagnostic tool, to assess suspected myocarditis associated with COVID‐19 vaccination 5–105 . One narrative review article attempted to address the pattern of myocardial injury following COVID‐19 vaccination based on cardiac MRI findings from 11 case series 4 .…”

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confidence: 99%

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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%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…More than half (55.8%) of the patients had no PMH, while hypertension (6.5%) and asthma (5.2%) were among the most common comorbidities. Six patients (4.0%) were reported to have a previous history of myocarditis 41,46,49,[73][74][75] and a small number (10.6%) had a previous history of SARS-CoV-2 infection. 37,42,43,53,[75][76][77][78][79][80] In addition, none of the cases tested positive for COVID-19 at the time of presentation and only 5.6% presented with evidence of any other type of viral infection at the time of symptom onset.…”

Section: Clinical Presentationsmentioning

confidence: 99%

“…Among the case series, three received a 10/10 score 74,85,86 and the lowest score was received by one study (3/10), 47 with an overall mean score of 7.73. Having complete inclusion of participants were the highest scoring criteria (26/26%, 100%), while the least reported criteria was appropriate statistical analysis (10/26%, 38.5%) (Table S3).…”

Section: Elevated Cardiac Troponinmentioning

confidence: 99%

Cardiac complications following mRNA COVID‐19 vaccines: A systematic review of case reports and case series

Fazlollahi

Zahmatyar

Noori

et al. 2021

Reviews in Medical Virology

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There have been several local and systemic adverse events associated with mRNA COVID-19 vaccines. Pericarditis, myocarditis and myocardial infarction are examples of cardiac complications related to these vaccines. In this article, we conducted a systematic review of case reports and case series to identify the clinical profile, investigations, and management of reported cardiac complications post-mRNA COVID-19 vaccines. We systematically searched PubMed, Scopus, Web of Science, and Google Scholar, as well as the medRxiv preprint server, with terms including: 'SARS-CoV-2', 'COVID-19', 'messenger RNA vaccine*', 'mRNA-1273 vaccine', 'BNT162 vaccine', 'myocarditis', 'pericarditis', 'stroke' and 'Myocardial Ischemia' up to 25 September 2021. Studies were excluded if they were not case reports or case series, or reported cases from non-mRNA vaccines. Case reports and case series were included that investigated the potential cardiac complications associated with mRNA COVID-19 vaccines. The JBI checklist was used to assess quality and data synthesis was conducted using a qualitative methodology called narrative synthesis. Sixty-nine studies, including 43 case reports and 26 case series, were included. Myocarditis/myopericarditis and pericarditis were the most common adverse events among the 243 reported cardiac complications, post mRNA COVID-19 vaccination. Males with a median age of 21 years had the highest frequency of myocarditis. Almost three quarters (74.4%) of cases with myocarditis had received the BNT162b2 vaccine and 87.7% had received the second dose of the vaccine.Chest pain (96.1%) and fever (38.2%) were the most common presentations. CK-MB, troponin, and NT-proBNP were elevated in 100%, 99.5% and 78.3% of subjects, respectively. ST-segment abnormality was the most common electrocardiogram feature. Cardiac magnetic resonance imaging, which is the gold-standard approach for diagnosing myocarditis, was abnormal in all patients diagnosed with

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Myocarditis post-SARS-CoV-2 vaccination: a systematic review

Goyal

Ray

Mascarenhas

et al. 2022

QJM: An International Journal of Medicine

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Background Variable clinical criteria taken by medical professionals across the world for myocarditis following COVID-19 vaccination along with wide variation in treatment necessitates understanding and reviewing the same. Objectives and Methods A systematic review was conducted to elucidate the clinical findings, laboratory parameters, treatment and outcomes of individuals with Myocarditis after COVID-19 vaccination after registering with PROSPERO. Electronic databases including MEDLINE, EMBASE, PubMed, LitCovid, Scopus, ScienceDirect, Cochrane Library, Google Scholar, Web of Science were searched. Results A total of 85 articles encompassing 2184 patients were analysed. It was a predominantly male (73.4%) and young population (Mean age 25.5 ± 14.2 years) with most having taken an mRNA-based vaccines (99.4%). The mean duration from vaccination to symptom onset was 4.01 ± 6.99 days. Chest pain (90.1%), dyspnoea (25.7%) and fever (11.9%) were the most common symptoms. Only 2.3% had comorbidities. CRP was elevated in 83.3% and cardiac troponin in 97.6% patients. An abnormal ECG was reported in 979/1313 (74.6%) patients with ST-segment elevation being most common (34.9%). Echocardiographic data was available for 1243 patients (56.9%) of whom 288 (23.2%) had reduced left ventricular ejection fraction. NSAIDS (76.5%), steroids (14.1%) followed by colchicine (7.3%) were used for treatment. Only 6 patients died among 1317 of whom data was available. Conclusion Myocarditis following COVID-19 vaccination is often mild, seen more commonly in young healthy males and is followed by rapid recovery with conservative treatment. The emergence of this adverse event calls for harmonizing case definitions and definite treatment guidelines which require wider research.

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Myopericarditis after Covid-19 Vaccination – a Case Series

Cited by 4 publications

References 0 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

Cardiac complications following mRNA COVID‐19 vaccines: A systematic review of case reports and case series

Myocarditis post-SARS-CoV-2 vaccination: a systematic review

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