Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination.

Autor:	Truong DT; Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., L.M.L.)., Dionne A; Department of Cardiology, Boston Children's Hospital, Department of Pediatrics; Harvard Medical School, MA (A.D., J.W.N.)., Muniz JC; Nicklaus Children's Hospital, Miami, FL (J.C.M.)., McHugh KE; Department of Pediatrics, Medical University of South Carolina, Charleston (K.E.M., A.M.A.)., Portman MA; Seattle Children's, Department of Pediatrics, University of Washington (M.A.P., J.S.)., Lambert LM; Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., L.M.L.)., Thacker D; Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE (D.T., S.S.)., Elias MD; Division of Cardiology, The Children's Hospital of Philadelphia, PA (M.D.E., T.M.G.)., Li JS; Duke University School of Medicine, Durham, NC (J.S.L., M.J.C.)., Toro-Salazar OH; Connecticut Children's Medical Center and University of Connecticut School of Medicine, Farmington (O.H.T.-S.)., Anderson BR; Division of Pediatric Cardiology; NewYork-Presbyterian/Columbia University Irving Medical Center (B.R.A.)., Atz AM; Department of Pediatrics, Medical University of South Carolina, Charleston (K.E.M., A.M.A.)., Bohun CM; Oregon Health & Science University, Division of Pediatric Cardiology, Department of Pediatrics, Portland (C.M.B., C.R.)., Campbell MJ; Duke University School of Medicine, Durham, NC (J.S.L., M.J.C.)., Chrisant M; The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (M.C., L.D.'A.)., D'Addese L; The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (M.C., L.D.'A.)., Dummer KB; Division of Pediatric Cardiology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego (K.B.D.)., Forsha D; Division of Pediatric Cardiology, Children's Mercy, Kansas City, MO (D.F.)., Frank LH; Division of Cardiology, Children's National Hospital, Washington, DC (L.H.F., A.K.)., Frosch OH; Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (O.H.F., S.K.G.)., Gelehrter SK; Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (O.H.F., S.K.G.)., Giglia TM; Division of Cardiology, The Children's Hospital of Philadelphia, PA (M.D.E., T.M.G.)., Hebson C; Children's of Alabama Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham School of Medicine (C.H.)., Jain SS; Maria Fareri Children's Hospital at Westchester Medical Center/New York Medical College, Valhalla (S.S.J.)., Johnston P; University of North Carolina at Chapel Hill (P.J., J.R.S.)., Krishnan A; Division of Cardiology, Children's National Hospital, Washington, DC (L.H.F., A.K.)., Lombardi KC; Warren Alpert Medical School of Brown University; Division of Pediatric Cardiology, Hasbro Children's Hospital, Providence, RI (K.C.L.)., McCrindle BW; Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (B.W.M., T.M.)., Mitchell EC; Cohen Children's Medical Center (Northwell Health), New Hyde Park, NY (E.C.M.)., Miyata K; Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego, La Jolla and Rady Children's Hospital San Diego (K.M.)., Mizzi T; Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (B.W.M., T.M.)., Parker RM; Division of Critical Care, Connecticut Children's, Hartford (R.M.P.)., Patel JK; Division of Pediatric Cardiology, Riley Children's Hospital, Indianapolis, IN (J.K.P.)., Ronai C; Oregon Health & Science University, Division of Pediatric Cardiology, Department of Pediatrics, Portland (C.M.B., C.R.)., Sabati AA; Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.A.S.)., Schauer J; Seattle Children's, Department of Pediatrics, University of Washington (M.A.P., J.S.)., Sexson Tejtel SK; Baylor College of Medicine, Texas Children's Hospital, Houston, TX (S.K.S.T., L.S.S.)., Shea JR; University of North Carolina at Chapel Hill (P.J., J.R.S.)., Shekerdemian LS; Baylor College of Medicine, Texas Children's Hospital, Houston, TX (S.K.S.T., L.S.S.)., Srivastava S; Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE (D.T., S.S.)., Votava-Smith JK; Division of Cardiology (J.K.V.-S.), Children's Hospital Los Angeles and Keck School of USC, CA., White S; Division of Hospital Medicine (S.W.), Children's Hospital Los Angeles and Keck School of USC, CA., Newburger JW; Department of Cardiology, Boston Children's Hospital, Department of Pediatrics; Harvard Medical School, MA (A.D., J.W.N.).
Jazyk:	angličtina
Zdroj:	Circulation [Circulation] 2022 Feb; Vol. 145 (5), pp. 345-356. Date of Electronic Publication: 2021 Dec 06.
DOI:	10.1161/CIRCULATIONAHA.121.056583
Abstrakt:	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.
Databáze:	MEDLINE
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