TY - JOUR
T1 - Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults
T2 - Suspected Myocarditis After COVID-19 Vaccination
AU - Truong, Dongngan T.
AU - Dionne, Audrey
AU - Muniz, Juan Carlos
AU - McHugh, Kimberly E.
AU - Portman, Michael A.
AU - Lambert, Linda M.
AU - Thacker, Deepika
AU - Elias, Matthew D.
AU - Li, Jennifer S.
AU - Toro-Salazar, Olga H.
AU - Anderson, Brett R.
AU - Atz, Andrew M.
AU - Bohun, C. Monique
AU - Campbell, M. Jay
AU - Chrisant, Maryanne
AU - D'Addese, Laura
AU - Dummer, Kirsten B.
AU - Forsha, Daniel
AU - Frank, Lowell H.
AU - Frosch, Olivia H.
AU - Gelehrter, Sarah K.
AU - Giglia, Therese M.
AU - Hebson, Camden
AU - Jain, Supriya S.
AU - Johnston, Pace
AU - Krishnan, Anita
AU - Lombardi, Kristin C.
AU - McCrindle, Brian W.
AU - Mitchell, Elizabeth C.
AU - Miyata, Koichi
AU - Mizzi, Trent
AU - Parker, Robert M.
AU - Patel, Jyoti K.
AU - Ronai, Christina
AU - Sabati, Arash A.
AU - Schauer, Jenna
AU - Tejtel, S. Kristen Sexson
AU - Shea, J. Ryan
AU - Shekerdemian, Lara S.
AU - Srivastava, Shubhika
AU - Votava-Smith, Jodie K.
AU - White, Sarah
AU - Newburger, Jane W.
N1 - Publisher Copyright:
© 2021 American Heart Association, Inc.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - 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.
AB - 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.
KW - COVID-19 vaccines
KW - adolescent
KW - myocarditis
KW - young adult
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U2 - 10.1161/CIRCULATIONAHA.121.056583
DO - 10.1161/CIRCULATIONAHA.121.056583
M3 - Article
C2 - 34865500
AN - SCOPUS:85122879328
SN - 0009-7322
VL - 145
SP - 345
EP - 356
JO - Circulation
JF - Circulation
IS - 5
ER -