Outcome and Morphofunctional Changes on Cardiac Magnetic Resonance in Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination

Ammirati, Enrico; Lupi, L; Palazzini, Matteo; Ciabatti, Michele; Rossi, Valentina A.; Gentile, Piero; Uribarri, Aitor; Vecchio, Chiara; Nassiacos, Daniele; Cereda, Alberto; Conca, Cristina; Tumminello, Gabriele; Meneveau, Nicolas; Lelarge, C; Pedrotti, Patrizia; Stucchi, Miriam; Peretto, Giovanni; Galasso, Michele; Huang, Florent; Ianni, Umberto; Procopio, Antonio; Saponara, Gianluigi; Cimaglia, Paolo; Tomasoni, Daniela; Moroni, Francesco; Turco, Annalisa; Sala, Simone; Tano, Giuseppe Di; Bollano, Entela; Moro, Claudio; Abbate, Antonio; Bona, Roberta Della; Porto, Italo; Carugo, Stefano; Campodonico, Jeness; Grosu, Aurelia; Bolognese, Leonardo; Salamanca, Jorge; Díez‐Villanueva, Pablo; Ozierański, Krzysztof; Tymińska, Agata; Infirri, Loren Sardo; Bromage, Daniel I; Cannatà, Antonio; Hong, Kimberly N.; Adamo, Marianna; Quattrocchi, G; Foà, Alberto; Potena, Luciano; Garascia, Andrea; Giannattasio, Cristina; Adler, Eric; Sinagra, Gianfranco; Ruschitzka, Frank; Camici, Paolo G.; Pieroni, Maurizio

doi:10.1161/circheartfailure.122.010315

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…This is particularly relevant in the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic, where AM has been associated with both the virus and vaccines against it. 42 – 44 Due to the rapidly evolving nature of the pandemic and urgent need for data, many early studies relied on ICD codes to identify cases of COVID-19- and vaccine-associated AM. This approach, however, may lead to study populations which are not truly representative of the disease processes being investigated.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy, clinical characteristics, and prognostic differences of patients with acute myocarditis according to inclusion criteria

Roy,

Cannata,

Al-Agil

et al. 2023

European Heart Journal - Quality of Care and Clinical Outcomes

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Introduction The diagnosis of acute myocarditis (AM) is complex due to its heterogeneity and typically is defined by either Electronic Healthcare Records (EHRs) or advanced imaging and endomyocardial biopsy, but there is no consensus. We aimed to investigate the diagnostic accuracy of these approaches for AM. Methods Data on ICD 10th Revision(ICD-10) codes corresponding to AM were collected from two hospitals and compared to cardiac magnetic resonance (CMR)-confirmed or clinically suspected (CS)-AM cases with respect to diagnostic accuracy, clinical characteristics, and all-cause mortality. Next, we performed a review of published AM studies according to inclusion criteria. Results We identified 291 unique admissions with ICD-10 codes corresponding to AM in the first three diagnostic positions. The positive predictive value of ICD-10 codes for CMR-confirmed or CS-AM was 36%, and patients with CMR-confirmed or CS-AM had a lower all-cause mortality than those with a refuted diagnosis (P = 0.019). Using an unstructured approach, patients with CMR-confirmed and CS-AM had similar demographics, comorbidity profiles and survival over a median follow-up of 52 months (P = 0.72). Our review of the literature confirmed our findings. Outcomes for patients included in studies using CMR-confirmed criteria were favourable compared to studies with endomyocardial biopsy-confirmed AM cases. Conclusion ICD-10 codes have poor accuracy in identification of AM cases and should be used with caution in clinical research. There are important differences in management and outcomes of patients according to the selection criteria used to diagnose AM. Potential selection biases must be considered when interpreting AM cohorts and requires standardization of inclusion criteria for AM studies.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy, clinical characteristics, and prognostic differences of patients with acute myocarditis according to inclusion criteria

Roy,

Cannata,

Al-Agil

et al. 2023

European Heart Journal - Quality of Care and Clinical Outcomes

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“…Importantly, a quarter of all patients examined were prescribed daily medications (e.g., colchicine, beta-blocker, non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, diuretics, corticosteroids, angiotensin II receptor blockers). In an analysis by Ammirati et al, among 75 patients with an available follow-up, no patient died or required hospitalization after a median time of 147 days [ 187 ]. A total of 10.6% of patients with an available follow-up CMR (n = 49) had a dilated LV, while 20.4% had persistent edema, and 79.6% had a residual scar based on late gadolinium enhancement.…”

Section: Autoimmune Myocarditis and Drug-induced Myocarditismentioning

confidence: 99%

Myocarditis: Etiology, Pathogenesis, and Their Implications in Clinical Practice

Brociek

Tymińska

Giordani

et al. 2023

Biology

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Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious agents. It can lead to serious short-term and long-term sequalae, such as sudden cardiac death or dilated cardiomyopathy. Due to its heterogenous clinical presentation and disease course, challenging diagnosis and limited evidence for prognostic stratification, myocarditis poses a great challenge to clinicians. As it stands, the pathogenesis and etiology of myocarditis is only partially understood. Moreover, the impact of certain clinical features on risk assessment, patient outcomes and treatment options is not entirely clear. Such data, however, are essential in order to personalize patient care and implement novel therapeutic strategies. In this review, we discuss the possible etiologies of myocarditis, outline the key processes governing its pathogenesis and summarize best available evidence regarding patient outcomes and state-of-the-art therapeutic approaches.

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“…In correspondence with the COVID-19 outbreak and the development of an appropriate vaccination, a higher-than-expected rate of messenger RNA vaccine-related myocarditis has been observed. Although the underlying mechanisms still remain unclear, both short-term and midterm prognoses have been reported to be favorable, thus prompting vaccination due to a clear benefit compared to associated risks [ 15 ].…”

Section: Acute Myocarditismentioning

confidence: 99%

Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis

Uccello,

Bonacchi,

Rossi

et al. 2023

JCM

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Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term “chronic inflammatory cardiomyopathy” describes a persistent/chronic inflammatory condition with a clinical phenotype of dilated and/or hypokinetic cardiomyopathy associated with symptoms of heart failure and increased risk for arrhythmias. A continuum can be identified between these two conditions. The importance of early diagnosis has grown markedly in the contemporary era with various diagnostic tools available. While cardiac magnetic resonance (CMR) is valid for diagnosis and follow-up, endomyocardial biopsy (EMB) should be considered as a first-line diagnostic modality in all unexplained acute cardiomyopathies complicated by hemodynamic instability and ventricular arrhythmias, considering the local expertise. Genetic counseling should be recommended in those cases where a genotype–phenotype association is suspected, as this has significant implications for patients’ and their family members’ prognoses. Recognition of the pathophysiological pathway and clinical “red flags” and an early diagnosis may help us understand mechanisms of progression, tailor long-term preventive and therapeutic strategies for this complex disease, and ultimately improve clinical outcomes.

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Outcome and Morphofunctional Changes on Cardiac Magnetic Resonance in Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination

Cited by 6 publications

References 5 publications

Diagnostic accuracy, clinical characteristics, and prognostic differences of patients with acute myocarditis according to inclusion criteria

Diagnostic accuracy, clinical characteristics, and prognostic differences of patients with acute myocarditis according to inclusion criteria

Myocarditis: Etiology, Pathogenesis, and Their Implications in Clinical Practice

Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis

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