Division of Cardiovascular Medicine, Krannert Cardiovascular Institute, Indiana University School of Medicine, 1801 North Senate Boulevard Suite 2000, Indianapolis, IN, 46202, USA.
Heart Fail Rev. 2022 Nov;27(6):2033-2043. doi: 10.1007/s10741-022-10243-9. Epub 2022 Apr 22.
Clinical course and outcomes of myocarditis after COVID-19 vaccination remain variable. We retrospectively collected data on patients > 12 years old from 01/01/2021 to 12/30/2021 who received COVID-19 messenger RNA (mRNA) vaccination and were diagnosed with myocarditis within 60 days of vaccination. Myocarditis cases were based on case definitions by authors. We report on 238 patients of whom most were male (n = 208; 87.1%). The mean age was 27.4 ± 16 (range 12-80) years. Females presented at older ages (41.3 ± 21.5 years) than men 25.7 ± 14 years (p = 0.001). In patients > 20 years of age, the mean duration from vaccination to symptoms was 4.8 days ± 5.5 days, but in < 20, it was 3.0 ± 3.3 days (p = 0.04). Myocarditis occurred most commonly after the Pfizer-BioNTech mRNA vaccine (n = 183; 76.45) and after the second dose (n = 182; 80%). Symptoms started 3.95 ± 4.5 days after vaccination. The commonest symptom was chest pain (n = 221; 93%). Patients were treated with non-steroidal anti-inflammatory drugs (n = 105; 58.3%), colchicine (n = 38; 21.1%), or glucocorticoids (n = 23; 12.7%). About 30% of the patients had left ventricular ejection fraction but more than half recovered the on repeat imaging. Abnormal cardiac MRIs were common; 168 patients (96% of 175 patients that had MRI) had late gadolinium enhancement, while 120 patients (68.5%) had myocardial edema. Heart failure guideline-directed medical therapy use was common (n = 27; 15%). Eleven patients had cardiogenic shock; and 4 patients required mechanical circulatory support. Five patients (1.7%) died; of these, 3 patients had endomyocardial biopsy/autopsy-confirmed myocarditis. Most cases of COVID-19 vaccine myocarditis are mild. Females presented at older ages than men and duration from vaccination to symptoms was longer in patients > 20 years. Cardiogenic shock requiring mechanical circulatory support was seen and mortality was low. Future studies are needed to better evaluate risk factors, and long-term outcomes of COVID-19 mRNA vaccine myocarditis.
COVID-19 疫苗接种后心肌炎的临床病程和转归仍存在差异。我们回顾性地收集了 2021 年 1 月 1 日至 2021 年 12 月 30 日期间 12 岁以上因 COVID-19 信使 RNA（mRNA）疫苗接种后 60 天内诊断为心肌炎的患者的数据。心肌炎病例是根据作者的病例定义确定的。我们报告了 238 例患者，其中大多数为男性（n=208；87.1%）。平均年龄为 27.4±16 岁（范围 12-80 岁）。女性的发病年龄大于男性（41.3±21.5 岁比 25.7±14 岁；p=0.001）。在年龄大于 20 岁的患者中，从接种疫苗到出现症状的平均时间为 4.8±5.5 天，但年龄小于 20 岁的患者为 3.0±3.3 天（p=0.04）。心肌炎最常发生在辉瑞-生物技术公司的 mRNA 疫苗（n=183；76.45%）和第二剂疫苗（n=182；80%）之后。症状在接种疫苗后 3.95±4.5 天开始出现。最常见的症状是胸痛（n=221；93%）。患者接受非甾体抗炎药（n=105；58.3%）、秋水仙碱（n=38；21.1%）或糖皮质激素（n=23；12.7%）治疗。约 30%的患者左心室射血分数异常，但超过一半的患者在重复影像学检查中恢复正常。异常的心脏磁共振成像很常见；175 例接受 MRI 的患者中有 168 例（96%）有晚期钆增强，120 例（68.5%）有心肌水肿。心力衰竭指南指导的药物治疗使用率很高（n=27；15%）。11 例患者发生心源性休克；4 例患者需要机械循环支持。5 例患者（1.7%）死亡；其中 3 例患者的心肌活检/尸检证实为心肌炎。大多数 COVID-19 疫苗接种后心肌炎为轻症。女性的发病年龄大于男性，年龄大于 20 岁的患者从接种疫苗到出现症状的时间更长。需要机械循环支持的心源性休克也有发生，死亡率较低。未来需要进一步研究以更好地评估 COVID-19 mRNA 疫苗接种后心肌炎的危险因素和长期结局。
