World Blog by humble servant. American Heart Association Warns About Vaccines

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

Dongngan T. Truong, MD, MShttps://orcid.org/0000-0002-1783-6061, Audrey Dionne, MDhttps://orcid.org/0000-0003-2864-1830, Juan Carlos Muniz, MD, Kimberly E. McHugh, MD, MSCR, Michael A. Portman, MD, Linda M. Lambert, APRN, Deepika Thacker, MD, Matthew D. Elias, MDhttps://orcid.org/0000-0002-9534-2809, Jennifer S. Li, MD, Olga H. Toro-Salazar, MD, Brett R. Anderson, MD, MBA, MS, Andrew M. Atz, MD, C. Monique Bohun, MB BChhttps://orcid.org/0000-0002-4554-5392, M. Jay Campbell, MD, MHAhttps://orcid.org/0000-0002-5210-9038, Maryanne Chrisant, MD, Laura D’Addese, MDhttps://orcid.org/0000-0002-7625-6577, Kirsten B. Dummer, MDhttps://orcid.org/0000-0001-9484-4770, Daniel Forsha, MD, Lowell H. Frank, MD, Olivia H. Frosch, MDhttps://orcid.org/0000-0003-2241-7838, Sarah K. Gelehrter, MD, Therese M. Giglia, MD, Camden Hebson, MD, Supriya S. Jain, MD, Pace Johnston, MD, Anita Krishnan, MDhttps://orcid.org/0000-0002-8662-7810, Kristin C. Lombardi, MD, Brian W. McCrindle, MD, MPHhttps://orcid.org/0000-0001-6485-6551, Elizabeth C. Mitchell, MDhttps://orcid.org/0000-0002-2830-1978, Koichi Miyata, MDhttps://orcid.org/0000-0002-2049-5309, Trent Mizzi, MD, Robert M. Parker, DO, Jyoti K. Patel, MD, Christina Ronai, MD, MSEdhttps://orcid.org/0000-0002-1503-7100, Arash A. Sabati, MDhttps://orcid.org/0000-0002-8146-6819, Jenna Schauer, MD, S. Kristen Sexson Tejtel, MD, PhD, MPH, J. Ryan Shea, MDhttps://orcid.org/0000-0002-5878-2880, Lara S. Shekerdemian, MB ChB, MD, MHA, Shubhika Srivastava, MD, MBBS, Jodie K. Votava-Smith, MD, Sarah White, MD, and Jane W. Newburger, MD, MPHhttps://orcid.org/0000-0002-7794-9017

BACKGROUND:

Understanding the clinical course and short-term outcomes of suspected myocarditis after the coronavirus disease 2019 (COVID-19) v

accination 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.

Key Words: adolescent ■ COVID-19 vaccines ■ myocarditis ■ young adult