Evertz Ruben, Schulz Alexander, Lange Torben, Backhaus Sören J, Vollmann Dirk, Kowallick Johannes T, von Haehling Stephan, Hasenfuß Gerd, Schuster Andreas
Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.
German Center for Cardiovascular Research (DZHK), Göttingen, Germany.
Front Cardiovasc Med. 2022 Aug 23;9:965512. doi: 10.3389/fcvm.2022.965512. eCollection 2022.
The risk of myocarditis after mRNA vaccination against COVID-19 has emerged recently. Current evidence suggests that young male patients are predominantly affected. In the majority of the cases, only mild symptoms were observed. However, little is known about cardiac magnetic resonance (CMR) imaging patterns in mRNA-related myocarditis and their differences when compared to classical viral myocarditis in the acute phase of inflammation.
In total, 10 mRNA vaccination-associated patients with myocarditis were retrospectively enrolled in this study and compared to 10 patients suffering from viral myocarditis, who were matched for age, sex, comorbidities, and laboratory markers. All patients ( = 20) were hospitalized and underwent a standardized clinical examination, as well as an echocardiography and a CMR. Both, clinical and imaging findings and, in particular, functional and volumetric CMR assessments, as well as detailed tissue characterization using late gadolinium enhancement and T1 + T2-weighted sequences, were compared between both groups. The median age of the overall cohort was 26 years (group 1: 25.5; group 2: 27.5; = 0.57). All patients described chest pain as the leading reason for their initial presentation. CMR volumetric and functional parameters did not differ significantly between both groups. In all cases, the lateral left ventricular wall showed late gadolinium enhancement without significant differences in terms of the localization or in-depth tissue characterization (late gadolinium enhancement [LGE] enlargement: group 1: 5.4%; group 2: 6.5%; = 0.14; T2 global/maximum value: group 1: 38.9/52 ms; group 2: 37.8/54.5 ms; = 0.79 and = 0.80).
This study yielded the first evidence that COVID-19 mRNA vaccine-associated myocarditis does not show specific CMR patterns during the very acute stage in the most affected patient group of young male patients. The observed imaging markers were closely related to regular viral myocarditis in our cohort. Additionally, we could not find any markers implying adverse outcomes in this relatively little number of patients; however, this has to be confirmed by future studies that will include larger sample sizes.
新冠病毒mRNA疫苗接种后发生心肌炎的风险最近才出现。目前的证据表明，年轻男性患者受影响最为严重。在大多数病例中，仅观察到轻微症状。然而，对于mRNA相关心肌炎的心脏磁共振（CMR）成像模式及其在炎症急性期与经典病毒性心肌炎相比的差异，我们知之甚少。
本研究共回顾性纳入了10例与mRNA疫苗接种相关的心肌炎患者，并与10例病毒性心肌炎患者进行比较，后者在年龄、性别、合并症和实验室指标方面相匹配。所有20例患者均住院，并接受了标准化临床检查、超声心动图检查和CMR检查。对两组患者的临床和影像学检查结果，特别是CMR的功能和容积评估，以及使用钆延迟增强和T1 + T2加权序列进行的详细组织特征分析进行了比较。整个队列的中位年龄为26岁（第1组：25.5岁；第2组：27.5岁；P = 0.57）。所有患者均称胸痛是其最初就诊的主要原因。两组之间CMR容积和功能参数无显著差异。在所有病例中，左心室侧壁均显示钆延迟增强，在定位或深度组织特征方面无显著差异（钆延迟增强[LGE]扩大：第1组：5.4%；第2组：6.5%；P = 0.14；T2全局/最大值：第1组：38.9/52毫秒；第2组：37.8/54.5毫秒；P = 0.79和P = 0.80）。
本研究首次证明，在受影响最严重的年轻男性患者群体的极急性期，新冠病毒mRNA疫苗相关心肌炎未表现出特定的CMR模式。在我们的队列中，观察到的影像学标志物与普通病毒性心肌炎密切相关。此外，在这相对少数的患者中，我们未发现任何预示不良结局的标志物；然而，这必须通过未来纳入更大样本量的研究来证实。
