Predictors of persistent symptoms after mRNA SARS-CoV-2 vaccine-related myocarditis (myovacc registry)

Abstract

AimsEpidemiological surveillance has raised safety concerns for mRNA SARS-CoV-2-vaccination-related myocarditis. We aimed to analyze epidemiological, clinical and imaging findings associated with clinical outcomes in these patients in an international multi-center registry (NCT05268458).Methods and resultsPatients with clinical and CMR diagnosis of acute myocarditis within 30 days after mRNA SARS-CoV-2—vaccination were included from five centers in Canada and Germany between 05/21 and 01/22. Clinical follow-up on persistent symptoms was collected. We enrolled 59 patients (80% males, mean age 29 years) with CMR-derived mild myocarditis (hs-Troponin-T 552 [249–1,193] ng/L, CRP 28 [13–51] mg/L; LVEF 57 ± 7%, LGE 3 [2–5] segments). Most common symptoms at baseline were chest pain (92%) and dyspnea (37%). Follow-up data from 50 patients showed overall symptomatic burden improvement. However, 12/50 patients (24%, 75% females, mean age 37 years) reported persisting symptoms (median interval 228 days) of chest pain (n = 8/12, 67%), dyspnea (n = 7/12, 58%), with increasing occurrence of fatigue (n = 5/12, 42%) and palpitations (n = 2/12, 17%). These patients had initial lower CRP, lower cardiac involvement in CMR, and fewer ECG changes. Significant predictors of persisting symptoms were female sex and dyspnea at initial presentation. Initial severity of myocarditis was not associated with persisting complaints.ConclusionA relevant proportion of patients with mRNA SARS-CoV-2-vaccination-related myocarditis report persisting complaints. While young males are usually affected, patients with persisting symptoms were predominantly females and older. The severity of the initial cardiac involvement not predicting these symptoms may suggest an extracardiac origin.

mRNA-LNP COVID-19 vaccine lipids induce low level complement activation and production of proinflammatory cytokines: Mechanisms, effects of complement inhibitors, and relevance to adverse reactions

“…anaphylatoxin/cytokine double hit) and start of symptoms can be reconciled. Examples for acute, subacute and chronic SAEs include the HSRs or anaphylaxis within minutes to hours [16][17][18][19] , heart inflammation [8][9][10][11][12][13][14][15] , coagulation disorders [21][22][23][24] , or skin diseases [25][26][27][28] can occur within days to months, and autoimmune phenomena 20 may arise without currently foreseeable time limit. A hypothesis that may explain these different latency periods postulates that the actions of effector immune cells, including the mast cells, basophil and neutrophil granulocytes, lymphocytes, macrophages and platelets, are discontinuous, graded in the sense that they manifest only after the activation state of their intracellular inflammatory signaling network reaches the reaction threshold.…”

“…Table 1 lists the vaccine's reported AEs categorized according to the affected organ systems. Of note, myocarditis/pericarditis [8][9][10][11][12][13][14][15] , HSRs/anaphylaxis [16][17][18][19] , autoimmune diseases 20 , thrombosis, thrombocytopenia and other coagulation disorders [21][22][23][24] skin [25][26][27][28] and ocular inflammations [29][30][31] , Guillain-Barre syndrome [32][33][34][35][36][37][38] and other neurologic problems 39,40 can all be linked to acute or subacute inflammatory processes that are also characteristic of SARS-CoV-2 infections.…”

mRNA-LNP COVID-19 Vaccine Lipids Induce Complement Activation and Production of Proinflammatory Cytokines: Mechanisms, Effects of Complement Inhibitors, and Relevance to Adverse Reactions

“…Table 1 lists the AEs reported or claimed for COVID-19 mRNA vaccines, categorized by the organ systems affected. Importantly, myocarditis/pericarditis [5][6][7][8][9][10][11][12], HSRs/anaphylaxis [13][14][15][16], autoimmune diseases [17], thrombosis, thrombocytopenia and other coagulation disorders [18][19][20][21], skin [22][23][24][25] and ocular inflammations [26][27][28], Guillain-Barré syndrome [29][30][31][32][33][34][35], and other neurologic problems [36,37] can all be linked to acute or chronic inflammatory processes that are also characteristic of SARS-CoV-2 infections.…”