Rosner et al.: 'Myocarditis Temporally Associated With COVID-19 Vaccination'; a case series of 7 patients hospitalized for acute myocarditis-like illness after COVID-19 vaccination, from 2 US medical
by Paul Alexander
centers in Falls Church, VA, and Dallas, TX. All were men <40 years of age and of White or Hispanic race/ethnicity; Six patients received an mRNA vaccine (Moderna or Pfizer/BioNTech)
All were hemodynamically stable and none had a pericardial friction rub or rash. ECG patterns varied from normal to ST segment elevation. Three patients underwent invasive coronary angiography, and none had evidence of obstructive coronary artery disease. Echocardiograms showed left ventricular ejection fraction ranging from 35% to 62%, with 5 of 7 having some degree of hypokinesis. Patients underwent cardiac magnetic resonance imaging between 3 and 37 days after vaccination, including multiplanar SSFP sequences, short axis T1 and T2 stacks, T1 mapping when available and multiplanar myocardial late gadolinium enhancement. Multifocal subepicardial late gadolinium enhancement was present in 7 of 7 patients and additional midmyocardial late gadolinium enhancement was 4 of 7 patients.
There was corresponding myocardial edema in 3 of 7 patients. Two patients who underwent cardiac magnetic resonance imaging >7 days from presentation had no edema, with an additional patient’s T2 images limited by artifact. One patient underwent endomyocardial biopsy without pathological evidence of myocarditis. No patients reported palpitations, and there was no evidence of sustained arrhythmias. No patients had evidence of an active viral illness or autoimmune disease, and 6 of 7 had polymerase chain reaction testing for acute COVID-19 infection during hospitalization (all 6 were negative). Assessment of COVID-19 serology was obtained for 6 of 7 patients, with 4 of 6 showing presence of spike protein IgG antibodies.’