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

Publication ,  Journal Article
Truong, DT; Dionne, A; Muniz, JC; McHugh, KE; Portman, MA; Lambert, LM; Thacker, D; Elias, MD; Li, JS; Toro-Salazar, OH; Anderson, BR; Atz, AM ...
Published in: Circulation
February 2022

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.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

February 2022

Volume

145

Issue

5

Start / End Page

345 / 356

Location

United States

Related Subject Headings

  • Young Adult
  • Time Factors
  • Retrospective Studies
  • Myocarditis
  • Male
  • Magnetic Resonance Imaging, Cine
  • Humans
  • Female
  • Electrocardiography
  • Child
 

Citation

APA
Chicago
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MLA
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Truong, D. T., Dionne, A., Muniz, J. C., McHugh, K. E., Portman, M. A., Lambert, L. M., … Newburger, J. W. (2022). Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination. Circulation, 145(5), 345–356. https://doi.org/10.1161/CIRCULATIONAHA.121.056583
Truong, Dongngan T., Audrey Dionne, Juan Carlos Muniz, Kimberly E. McHugh, Michael A. Portman, Linda M. Lambert, Deepika Thacker, et al. “Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination.Circulation 145, no. 5 (February 2022): 345–56. https://doi.org/10.1161/CIRCULATIONAHA.121.056583.
Truong DT, Dionne A, Muniz JC, McHugh KE, Portman MA, Lambert LM, et al. Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination. Circulation. 2022 Feb;145(5):345–56.
Truong, Dongngan T., et al. “Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination.Circulation, vol. 145, no. 5, Feb. 2022, pp. 345–56. Pubmed, doi:10.1161/CIRCULATIONAHA.121.056583.
Truong DT, Dionne A, Muniz JC, McHugh KE, Portman MA, Lambert LM, Thacker D, Elias MD, Li JS, Toro-Salazar OH, Anderson BR, Atz AM, Bohun CM, Campbell MJ, Chrisant M, D’Addese L, Dummer KB, Forsha D, Frank LH, Frosch OH, Gelehrter SK, Giglia TM, Hebson C, Jain SS, Johnston P, Krishnan A, Lombardi KC, McCrindle BW, Mitchell EC, Miyata K, Mizzi T, Parker RM, Patel JK, Ronai C, Sabati AA, Schauer J, Sexson Tejtel SK, Shea JR, Shekerdemian LS, Srivastava S, Votava-Smith JK, White S, Newburger JW. Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination. Circulation. 2022 Feb;145(5):345–356.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

February 2022

Volume

145

Issue

5

Start / End Page

345 / 356

Location

United States

Related Subject Headings

  • Young Adult
  • Time Factors
  • Retrospective Studies
  • Myocarditis
  • Male
  • Magnetic Resonance Imaging, Cine
  • Humans
  • Female
  • Electrocardiography
  • Child