Natural History of Myocardial Injury After COVID-19 Vaccine–Associated Myocarditis

Autor: Muhammad Mustafa Alhussein, Mohamad Rabbani, Bradley Sarak, Steven Dykstra, Dina Labib, Jacqueline Flewitt, Carmen P. Lydell, Andrew G. Howarth, Neil Filipchuck, Angela Kealey, Jillian Colbert, Nita Guron, Louis Kolman, Naeem Merchant, Murad Bandali, Mike Bristow, James A. White
Rok vydání: 2022
Předmět:
Zdroj: Canadian Journal of Cardiology. 38:1676-1683
ISSN: 0828-282X
DOI: 10.1016/j.cjca.2022.07.017
Popis: Acute myocarditis is a rare complication of mRNA-based COVID-19 vaccination. Little is known about the natural history of this complication.Baseline and convalescent (≥ 90 days) cardiac magnetic resonance (CMR) imaging assessments were performed in 20 consecutive patients meeting Updated Lake Louise Criteria for acute myocarditis within 10 days of mRNA-based vaccination. CMR-based changes in left ventricular volumes, mass, ejection fraction (LVEF), markers of tissue inflammation (native T1 and T2 mapping), and fibrosis (late gadolinium enhancement [LGE] and extracellular volume [ECV]) were assessed between baseline and convalescence. Cardiac symptoms and clinical outcomes were captured.Median age was 23.1 years (range 18-39 years), and 17 (85%) were male. Convalescent evaluations were performed at a median (IQR) 3.7 (3.3-6.2) months. The LVEF showed a mean 3% absolute improvement, accompanied by a 7% reduction in LV end-diastolic volume and 5% reduction in LV mass (all P0.015). Global LGE burden was reduced by 66% (P0.001). Absolute reductions in global T2, native T1, and ECV of 2.1 ms, 58 ms, and 2.9%, repectively, were documented (all P ≤ 0.001). Of 5 patients demonstrating LVEF ≤ 50% at baseline, all recovered to above this threshold in convalescence. A total of 18 (90%) patients showed persistence of abnormal LGE although mean fibrosis burden was5% of LV mass in 85% of cases. No patient experienced major clinical outcomes.COVID-19 mRNA vaccine-associated myocarditis showed rapid improvements in CMR-based markers of edema, contractile function, and global LGE burden beyond 3 months of recovery in this young patient cohort. However, regional fibrosis following edema resolution was commonly observed, justifying need for ongoing surveillance.
Databáze: OpenAIRE
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