From the Department of Neonatology, Seth GSMC & KEMH, Acharya Donde Marg, Parel East, Parel, Mumbai, Maharashtra 400012, India.
Department of Medicine, Mahatma Gandhi Memorial Medical College, AB Rd, CRP Line, Indore, Madhya Pradesh 452001, India.
QJM. 2023 Feb 14;116(1):7-25. doi: 10.1093/qjmed/hcac064.
Variable clinical criteria taken by medical professionals across the world for myocarditis following coronavirus disease 2019 (COVID-19) vaccination along with wide variation in treatment necessitates understanding and reviewing the same. A systematic review was conducted to elucidate the clinical findings, laboratory parameters, treatment and outcomes of individuals with myocarditis after COVID-19 vaccination after registering with PROSPERO. Electronic databases including MEDLINE, EMBASE, PubMed, LitCovid, Scopus, ScienceDirect, Cochrane Library, Google Scholar and Web of Science were searched. A total of 85 articles encompassing 2184 patients were analysed. It was a predominantly male (73.4%) and young population (mean age: 25.5 ± 14.2 years) with most having taken an mRNA-based vaccine (99.4%). The mean duration from vaccination to symptom onset was 4.01 ± 6.99 days. Chest pain (90.1%), dyspnoea (25.7%) and fever (11.9%) were the most common symptoms. Only 2.3% had comorbidities. CRP was elevated in 83.3% and cardiac troponin in 97.6% patients. An abnormal ECG was reported in 979/1313 (74.6%) patients with ST-segment elevation being most common (34.9%). Echocardiographic data were available for 1243 patients (56.9%), of whom 288 (23.2%) had reduced left ventricular ejection fraction. Non-steroidal antiinflammatory drugs (76.5%), steroids (14.1%) followed by colchicine (7.3%) were used for treatment. Only 6 patients died among 1317 of whom data were available. Myocarditis following COVID-19 vaccination is often mild, seen more commonly in young healthy males and is followed by rapid recovery with conservative treatment. The emergence of this adverse event calls for harmonizing case definitions and definite treatment guidelines, which require wider research.
全球医疗专业人员对 COVID-19 疫苗接种后心肌炎采用的可变临床标准以及治疗方法的广泛差异，需要对此进行理解和审查。我们进行了一项系统评价，以阐明 COVID-19 疫苗接种后心肌炎患者的临床发现、实验室参数、治疗和结局，该研究已在 PROSPERO 上注册。检索了 MEDLINE、EMBASE、PubMed、LitCovid、Scopus、ScienceDirect、Cochrane 图书馆、Google Scholar 和 Web of Science 等电子数据库。共分析了 85 篇文章，共包含 2184 例患者。这是一个以男性为主（73.4%）且年轻（平均年龄：25.5±14.2 岁）的人群，大多数人接种了基于 mRNA 的疫苗（99.4%）。从接种疫苗到症状出现的平均时间为 4.01±6.99 天。胸痛（90.1%）、呼吸困难（25.7%）和发热（11.9%）是最常见的症状。仅有 2.3%的患者合并症。83.3%的患者 C 反应蛋白升高，97.6%的患者心肌肌钙蛋白升高。1313 例患者中有 979 例（74.6%）心电图异常，最常见的是 ST 段抬高（34.9%）。1243 例患者有超声心动图数据（56.9%），其中 288 例（23.2%）左心室射血分数降低。非甾体抗炎药（76.5%）、类固醇（14.1%）和秋水仙碱（7.3%）用于治疗。在可获得数据的 1317 例患者中，仅有 6 例死亡。COVID-19 疫苗接种后心肌炎通常较轻，在年轻健康男性中更为常见，且采用保守治疗后可迅速恢复。这种不良事件的出现呼吁协调病例定义和明确的治疗指南，这需要更广泛的研究。
