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新型冠状病毒疫苗接种后的心肌炎:发病机制、临床表现、诊断、病理生理学、治疗和结局。该临床共识文件由欧洲心脏病学会心力衰竭协会(ESC)和 ESC 心肌和心包疾病工作组支持。

Myocarditis following COVID-19 vaccine: incidence, presentation, diagnosis, pathophysiology, therapy, and outcomes put into perspective. A clinical consensus document supported by the Heart Failure Association of the European Society of Cardiology (ESC) and the ESC Working Group on Myocardial and Pericardial Diseases.

机构信息

Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt, Universität zu Berlin, Berlin, Germany.

Clalit Health Services, Clalit Research Institute, Ramat Gan, Israel.

出版信息

Eur J Heart Fail. 2022 Nov;24(11):2000-2018. doi: 10.1002/ejhf.2669. Epub 2022 Oct 6.


DOI:10.1002/ejhf.2669
PMID:36065751
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9538893/
Abstract

Over 10 million doses of COVID-19 vaccines based on RNA technology, viral vectors, recombinant protein, and inactivated virus have been administered worldwide. Although generally very safe, post-vaccine myocarditis can result from adaptive humoral and cellular, cardiac-specific inflammation within days and weeks of vaccination. Rates of vaccine-associated myocarditis vary by age and sex with the highest rates in males between 12 and 39 years. The clinical course is generally mild with rare cases of left ventricular dysfunction, heart failure and arrhythmias. Mild cases are likely underdiagnosed as cardiac magnetic resonance imaging (CMR) is not commonly performed even in suspected cases and not at all in asymptomatic and mildly symptomatic patients. Hospitalization of symptomatic patients with electrocardiographic changes and increased plasma troponin levels is considered necessary in the acute phase to monitor for arrhythmias and potential decline in left ventricular function. In addition to evaluation for symptoms, electrocardiographic changes and elevated troponin levels, CMR is the best non-invasive diagnostic tool with endomyocardial biopsy being restricted to severe cases with heart failure and/or arrhythmias. The management beyond guideline-directed treatment of heart failure and arrhythmias includes non-specific measures to control pain. Anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs, and corticosteroids have been used in more severe cases, with only anecdotal evidence for their effectiveness. In all age groups studied, the overall risks of SARS-CoV-2 infection-related hospitalization and death are hugely greater than the risks from post-vaccine myocarditis. This consensus statement serves as a practical resource for physicians in their clinical practice, to understand, diagnose, and manage affected patients. Furthermore, it is intended to stimulate research in this area.

摘要

全球已接种超过 1000 万剂基于 RNA 技术、病毒载体、重组蛋白和灭活病毒的 COVID-19 疫苗。尽管通常非常安全,但疫苗接种后心肌炎可在接种后几天和几周内由适应性体液和细胞、心脏特异性炎症引起。疫苗相关性心肌炎的发生率因年龄和性别而异,男性在 12 至 39 岁之间的发生率最高。临床病程通常较轻,极少数情况下会出现左心室功能障碍、心力衰竭和心律失常。轻度病例可能诊断不足,因为即使在疑似病例中也很少进行心脏磁共振成像 (CMR),而在无症状和轻度症状患者中则根本不进行 CMR。对于有心电图改变和肌钙蛋白水平升高的症状性患者,在急性期需要住院,以监测心律失常和潜在的左心室功能下降。除了评估症状、心电图改变和肌钙蛋白水平升高外,CMR 是最佳的非侵入性诊断工具,而心肌活检仅限于心力衰竭和/或心律失常的严重病例。除了心力衰竭和心律失常的指南指导治疗外,还包括控制疼痛的非特异性措施。在更严重的情况下,已经使用了抗炎药,如非甾体抗炎药和皮质类固醇,但只有关于其有效性的零星证据。在所有研究的年龄组中,与 SARS-CoV-2 感染相关的住院和死亡风险远远大于疫苗接种后心肌炎的风险。本共识声明旨在为临床实践中的医生提供实用资源,以帮助他们理解、诊断和管理受影响的患者。此外,它旨在激发该领域的研究。

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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb17/9538893/321ac02bcd6f/EJHF-9999-0-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb17/9538893/6e2e28bedc73/EJHF-9999-0-g007.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb17/9538893/487a87acfd40/EJHF-9999-0-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb17/9538893/c271d8359a7d/EJHF-9999-0-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb17/9538893/6b89aa211cc7/EJHF-9999-0-g004.jpg

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