Myocarditis after BNT162b2 and mRNA-1273 vaccination

KF Larson, E Ammirati, ED Adler, LT Cooper Jr… - Circulation, 2021 - Am Heart Assoc
KF Larson, E Ammirati, ED Adler, LT Cooper Jr, KN Hong, G Saponara, D Couri, A Cereda…
Circulation, 2021Am Heart Assoc
(COVID-19) vaccines have gained widespread use across the globe to prevent further
spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Early
studies and surveillance data suggest these vaccines are associated with no significant
adverse events other than very rare anaphylaxis. 1, 2 Surveillance for other reactions
continues. Myocarditis and inflammatory myocardial cellular infiltrate have been reported
after vaccination, especially after the smallpox vaccine. 3 However, myocarditis occurring …
(COVID-19) vaccines have gained widespread use across the globe to prevent further spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Early studies and surveillance data suggest these vaccines are associated with no significant adverse events other than very rare anaphylaxis. 1, 2 Surveillance for other reactions continues. Myocarditis and inflammatory myocardial cellular infiltrate have been reported after vaccination, especially after the smallpox vaccine. 3 However, myocarditis occurring after the BNT162b2 mRNA and mRNA-1273 vaccines has not been reported in trials. 1, 2 Here, we describe 8 patients who were hospitalized with chest pain and who were diagnosed with myocarditis by laboratory and cardiac magnetic resonance imaging within 2 to 4 days of receiving either the BNT162b2 or mRNA-1273 vaccine (Table). Patients provided written informed consent, and the collection of clinical cases followed local Institutional Review Board requirements. The data that support the findings of this study are available from the corresponding author on reasonable request. Two of the patients (patients 3 and 4) had previously been infected by SARS-CoV-2 without need for hospitalization. All individuals were otherwise healthy males between the ages of 21 and 56 years. All but 1 patient developed symptoms after their second dose. Systemic symptoms began within 24 hours after vaccine administration in 5 out of 8 patients, with chest pain presenting between 48 and 96 hours later. Chest pain was most commonly described as constant, nonpositional, and nonpleuritic (only patient 7 reported pericardial pain), consistent with acute myocarditis mainly without pericardial involvement. Troponin values were elevated in all individuals and appeared to peak the day after admission, whereas no patient had eosinophilia. All patients were tested and were negative for SARS-CoV-2. Left ventricular ejection fraction was reduced (< 50%) in 2 of 8 (25%) patients with a median left ventricular ejection fraction of 51.5%(first to third quartile, 48% to 59%). Five patients demonstrated regional wall motion abnormalities with inferior and inferolateral walls involved, and the remaining 3 cases had generalized hypokinesis. Some patients were tachycardic at presentation, but no patients required inotropes or mechanical circulatory support. All but 3 patients (patients 1, 2, and 5) underwent coronary imaging by computed tomography or catheter-based angiography to rule out coronary artery disease. Cardiac magnetic resonance imaging revealed patchy delayed gadolinium enhancement consistent with myocarditis in all patients, and most patients also demonstrated findings consistent with myocardial edema. Cardiac biopsy, performed in 1 of the patients before steroid initiation, did not demonstrate myocardial infiltrate. All patients had resolution of their chest pain, were discharged from the hospital in stable condition, and were alive with preserved left ventricular ejection fraction at last contact. The patients presented here demonstrated typical signs, symptoms, and diagnostic features of acute
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