Myocarditis after COVID-19 vaccine treatable; AHA urges continued vaccination
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Seven patients who developed myocarditis-like symptoms after COVID-19 vaccination were able to recover after treatment, according to a case series published in Circulation.
As Healio previously reported, the CDC is investigating “relatively few” reports of myocarditis in young recipients of the messenger RNA-based COVID-19 vaccines. As of June 10, 226 cases had been reported compared with an expected 100 cases. A meeting of the CDC’s Advisory Committee on Immunization Practices to discuss the issue was supposed to be held June 18, but was postponed until June 23-25.
Symptoms after vaccine
In the Circulation publication, researchers documented seven male patients ranging in age from 19 to 39 years who had myocarditis-like symptoms after receiving a COVID-19 vaccine; five received Pfizer/BioNTech’s mRNA vaccine, one received Moderna’s mRNA vaccine and one received Johnson & Johnson’s non-mRNA vaccine. Treatments varied and included beta-blockers and anti-inflammatory agents, and all patients had their symptoms resolved by hospital discharge. The mean hospital length of stay was 3 days.
In a related press release, the American Heart Association said that the myocarditis reports should not dissuade people from getting vaccinated against COVID-19.
“The American Heart Association continues to urge all adults and children ages 12 and older in the U.S. to receive a COVID-19 vaccine as soon as they can, as recommended by the CDC. Research continues to indicate that the COVID-19 vaccines are 91% effective at preventing severe COVID-19 infection and spreading the virus to others. In addition, the benefits of vaccination far exceed the very unusual risks,” the AHA said in the release. “According to the CDC, fewer than 1,000 cases of myocarditis-like illnesses were reported as of May 31, 2021, and nearly 312 million doses of COVID-19 vaccines have been administered in the U.S. to date.”
Imaging, biomarker findings
In the Circulation paper, Carolyn M. Rosner, MSN, NP-C, MBA, nurse practitioner at Inova Health System, and colleagues wrote that all patients presented 3 to 7 days after vaccination with acute chest pain and evidence of myocardial injury based on cardiac troponin I or high-sensitivity troponin I. Three patients had invasive coronary angiography but none had evidence of obstructive CAD.
All patients had multifocal subepicardial late gadolinium enhancement on cardiac MRI and four had mid-myocardial late gadolinium enhancement, while three had evidence of myocardial edema, according to the researchers.
No patients had active viral illness or autoimmune disease, and the six patients tested for COVID-19 were negative, Rosner and colleagues wrote.
Four of the six patients tested for COVID-19 had evidence of spike protein IgG antibodies, according to the researchers.
“Our series of seven male COVID-19 vaccination recipients who presented with myocarditis-like illness supports a potential causal association with vaccination given the temporal relationship, clinical presentation and CMR findings,” Rosner and colleagues wrote. “Although endomyocardial biopsy was negative in the single case in which it was performed, this may represent sampling bias, given the patchy nature of myocardial inflammation in myocarditis. Of the two patients without measurable spike protein IgG, both presented shortly after their first vaccine dose. This antibody response is not unexpected, but may indicate an alternate vaccine-related immune mechanism or absence of causality with the vaccine. Additional study is needed to confirm if the rate of myocarditis-like illness is higher after vaccination than the background rate of myocarditis among similar-aged individuals in the population.”
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