Follow-up cardiac magnetic resonance in children with vaccine-associated myocarditis

• Published in: European journal of pediatrics Vol. 181; no. 7; pp. 2879 - 2883
• Main Authors: Hadley, Stephanie M., Prakash, Ashwin, Baker, Annette L., de Ferranti, Sarah D., Newburger, Jane W., Friedman, Kevin G., Dionne, Audrey
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2022; Springer Nature B.V
• Subjects: Adolescent; Adult; BNT162 Vaccine; Child; Children; Contrast Media - adverse effects; Coronaviruses; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - adverse effects; Follow-Up Studies; Gadolinium; Gadolinium - adverse effects; Heart diseases; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Medicine; Medicine & Public Health; mRNA; mRNA Vaccines; Myocarditis; Myocarditis - diagnostic imaging; Myocarditis - etiology; Myocardium - pathology; Patients; Pediatrics; Predictive Value of Tests; Short Communication; Vaccines, Synthetic; Ventricle; Ventricular Function, Left; Young Adult; Vaccine-associated myocarditis follow-up; COVID-19 mRNA vaccine; Late gadolinium enhancement; Cardiac magnetic resonance imaging
• ISSN: 1432-1076; 0340-6199; 1432-1076
• DOI: 10.1007/s00431-022-04482-z

Myocarditis is a rare complication of the COVID-19 mRNA vaccine. We previously reported a case series of 15 adolescents with vaccine-associated myocarditis, 87% of whom had abnormalities on initial cardiac magnetic resonance (CMR), including late gadolinium enhancement (LGE) in 80%. We performed follow-up CMRs to determine the trajectory of myocardial recovery and better understand the natural history of vaccine-associated myocarditis. Case series of patients age < 19 years admitted to Boston Children’s Hospital with acute vaccine-associated myocarditis following the BNT162b2 vaccine who had abnormal CMR at the time of initial presentation, and underwent follow-up testing. CMR assessment included left ventricular (LV) ejection fraction, T2-weighted myocardial imaging, LV global native T1, LV global T2, extracellular volume (ECV), and late gadolinium enhancement (LGE). Ten patients (9 male, median age 15 years) with vaccine-associated myocarditis underwent follow-up CMR at a median of 92 days (range 76–119) after hospital discharge. LGE was persistent in 80% of patients, though improved from prior in all cases. Two patients (20%) had abnormal LV global T1 at presentation, which normalized on follow-up. ECV decreased between acute presentation and follow-up in 6/10 patients; it remained elevated at follow-up in 1 patient and borderline in 3 patients.
Conclusion
: CMR performed ~3 months after admission for COVID-19 vaccine-associated myocarditis showed improvement of LGE in all patients, but persistent in the majority. Follow-up CMR 6–12 months after acute episode should be considered to better understand the long-term cardiac risks.
What is Known:
• Myocarditis is a rare side effect of COVID-19 mRNA vaccine
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•Late gadolinium enhancement is present on most cardiac magnetic resonance at the time of acute presentation
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What is New:
•Late gadolinium enhancement improved on all repeat cardiac magnetic resonance at 3-month follow-up
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•Most patients still had a small amount of late gadolinium enhancement, the clinical significance of which is yet to be determined
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