Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination. Issue 5 (6th December 2021)

• Record Type: Journal Article
• Authors: Truong, Dongngan T.; Dionne, Audrey; Muniz, Juan Carlos; McHugh, Kimberly E.; Portman, Michael A.; Lambert, Linda M.; Thacker, Deepika; Elias, Matthew D.; Li, Jennifer S.; Toro-Salazar, Olga H.; Anderson, Brett R.; Atz, Andrew M.; Bohun, C. Monique; Campbell, M. Jay; Chrisant, Maryanne; D'Addese, Laura; Dummer, Kirsten B.; Forsha, Daniel; Frank, Lowell H.; Frosch, Olivia H.; Gelehrter, Sarah K.; Giglia, Therese M.; Hebson, Camden; Jain, Supriya S.; Johnston, Pace; Krishnan, Anita; Lombardi, Kristin C.; McCrindle, Brian W.; Mitchell, Elizabeth C.; Miyata, Koichi; Mizzi, Trent; Parker, Robert M.; Patel, Jyoti K.; Ronai, Christina; Sabati, Arash A.; Schauer, Jenna; Sexson Tejtel, S. Kristen; Shea, J. Ryan; Shekerdemian, Lara S.; Srivastava, Shubhika; Votava-Smith, Jodie K.; White, Sarah; Newburger, Jane W.;
• Is Part Of: Circulation. Volume 145:Issue 5(2022)
• Page Start: 345
• Page End: 356
• Publication Date: 2021-12-06
• Subjects: adolescent -- COVID-19 vaccines -- myocarditis -- young adult; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.121.056583
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : Background: Understanding the clinical course and short-term outcomes of suspected myocarditis after the coronavirus disease 2019 (COVID-19) vaccination has important public health implications in the decision to vaccinate youth. Methods: We retrospectively collected data on patients <21 years old presenting before July 4, 2021, with suspected myocarditis within 30 days of COVID-19 vaccination. Lake Louise criteria were used for cardiac MRI findings. Myocarditis cases were classified as confirmed or probable on the basis of the Centers for Disease Control and Prevention definitions. Results: We report on 139 adolescents and young adults with 140 episodes of suspected myocarditis (49 confirmed, 91 probable) at 26 centers. Most patients were male (n=126, 90.6%) and White (n=92, 66.2%); 29 (20.9%) were Hispanic; and the median age was 15.8 years (range, 12.1–20.3; interquartile range [IQR], 14.5–17.0). Suspected myocarditis occurred in 136 patients (97.8%) after the mRNA vaccine, with 131 (94.2%) after the Pfizer-BioNTech vaccine; 128 (91.4%) occurred after the second dose. Symptoms started at a median of 2 days (range, 0–22; IQR, 1–3) after vaccination. The most common symptom was chest pain (99.3%). Patients were treated with nonsteroidal anti-inflammatory drugs (81.3%), intravenous immunoglobulin (21.6%), glucocorticoids (21.6%), colchicine (7.9%), or no anti-inflammatory therapies (8.6%). Twenty-six patients (18.7%) were in the intensive care unit, 2 were treated with inotropic/vasoactive support, and none required extracorporeal membrane oxygenation or died. Median hospital stay was 2 days (range, 0–10; IQR, 2–3). All patients had elevated troponin I (n=111, 8.12 ng/mL; IQR, 3.50–15.90) or T (n=28, 0.61 ng/mL; IQR, 0.25–1.30); 69.8% had abnormal ECGs and arrhythmias (7 with nonsustained ventricular tachycardia); and 18.7% had left ventricular ejection fraction <55% on echocardiogram. Of 97 patients who underwent cardiac MRI at a median 5 days (range, 0–88; IQR, 3–17) from symptom onset, 75 (77.3%) had abnormal findings: 74 (76.3%) had late gadolinium enhancement, 54 (55.7%) had myocardial edema, and 49 (50.5%) met Lake Louise criteria. Among 26 patients with left ventricular ejection fraction <55% on echocardiogram, all with follow-up had normalized function (n=25). Conclusions: Most cases of suspected COVID-19 vaccine myocarditis occurring in persons <21 years have a mild clinical course with rapid resolution of symptoms. Abnormal findings on cardiac MRI were frequent. Future studies should evaluate risk factors, mechanisms, and long-term outcomes.