Warren Josephine, Cheng Daryl, Crawford Nigel, Jones Bryn, Ng Rui Lun, Alafaci Annette, Stub Dion, Lew Philip, Taylor Andrew J
Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
Open Heart. 2025 Jul 18;12(2):e003333. doi: 10.1136/openhrt-2025-003333.
Myocarditis is a rare but potentially serious complication of COVID-19 vaccination. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging can identify cardiac scar, which may improve diagnostic accuracy and prognostication. We sought to define the incidence of long-term LGE post COVID-19 vaccine-associated myocarditis (C-VAM) and to establish the additive role of CMR in the diagnostic workup of this condition.
Patients with Brighton Collaboration Criteria Level 1 (definite) or Level 2 (probable) C-VAM were prospectively recruited from the Surveillance of Adverse Events Following Vaccination In the Community database to undergo CMR at least 6 months after diagnosis. As there were limited patients with access to baseline CMR, prior CMR results were not included in the initial case definition. The presence of LGE at follow-up CMR was then integrated into the diagnostic algorithm, and the reclassification rate (definite vs probable) was calculated.
67 patients with C-VAM (mean age 30±13 years, 72% male) underwent CMR evaluation. The median time from vaccination to CMR was 548 (range 398-603) days. 20 patients (30%) had LGE. At diagnosis, nine patients (13%) were classified as definite and 58 (87%) as probable myocarditis. With the integration of CMR-LGE data, 16 patients (28%) were reclassified from probable to definite myocarditis.
LGE on CMR occurred in one-third of patients with C-VAM. Without CMR at the time of diagnosis, almost one-third of patients are misclassified as probable rather than definite myocarditis, indicating a diagnostic strategy using echocardiography alone is insufficient.
心肌炎是新冠病毒疫苗接种罕见但可能严重的并发症。采用钆延迟增强（LGE）成像的心脏磁共振成像（CMR）可识别心脏瘢痕，这可能提高诊断准确性和预后评估。我们旨在确定新冠病毒疫苗相关心肌炎（C-VAM）后长期LGE的发生率，并确定CMR在该疾病诊断检查中的附加作用。
从社区疫苗接种后不良事件监测数据库中前瞻性招募符合布莱顿协作标准1级（确诊）或2级（可能）C-VAM的患者，在诊断后至少6个月接受CMR检查。由于能够进行基线CMR检查的患者有限，初始病例定义中未纳入既往CMR结果。然后将随访CMR时LGE的存在情况纳入诊断算法，并计算重新分类率（确诊与可能）。
67例C-VAM患者（平均年龄30±13岁，72%为男性）接受了CMR评估。从接种疫苗到CMR的中位时间为548天（范围398 - 603天）。20例患者（30%）出现LGE。诊断时，9例患者（13%）被分类为确诊心肌炎，58例（87%）为可能心肌炎。随着CMR-LGE数据的纳入，16例患者（28%）从可能心肌炎重新分类为确诊心肌炎。
CMR上的LGE出现在三分之一的C-VAM患者中。诊断时若未进行CMR检查，近三分之一的患者会被错误分类为可能而非确诊心肌炎，这表明仅使用超声心动图的诊断策略是不够的。
