Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination

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  • Truong, D.T.
    • Other Affiliation: University of Utah
  • Dionne, A.
    • Other Affiliation: Boston Children's Hospital
  • Muniz, J.C.
    • Other Affiliation: Nicklaus Children's Hospital
  • McHugh, K.E.
    • Other Affiliation: Medical University of South Carolina
  • Portman, M.A.
    • Other Affiliation: University of Washington
  • Lambert, L.M.
    • Other Affiliation: University of Utah
  • Thacker, D.
    • Other Affiliation: Nemours Children's Health
  • Elias, M.D.
    • Other Affiliation: The Children's Hospital of Philadelphia
  • Li, J.S.
    • Other Affiliation: Duke University
  • Toro-Salazar, O.H.
    • Other Affiliation: University of Connecticut
  • Anderson, B.R.
    • Other Affiliation: Columbia University Irving Medical Center
  • Atz, A.M.
    • Other Affiliation: Medical University of South Carolina
  • Bohun, C.M.
    • Other Affiliation: Oregon Health and Science University
  • Campbell, M.J.
    • Other Affiliation: Duke University
  • Chrisant, M.
    • Other Affiliation: Joe DiMaggio Children's Hospital
  • D'Addese, L.
    • Other Affiliation: Joe DiMaggio Children's Hospital
  • Dummer, K.B.
    • Other Affiliation: University of California San Diego
  • Forsha, D.
    • Other Affiliation: Children's Mercy
  • Frank, L.H.
    • Other Affiliation: Children's National Hospital
  • Frosch, O.H.
    • Other Affiliation: University of Michigan
  • Gelehrter, S.K.
    • Other Affiliation: University of Michigan
  • Giglia, T.M.
    • Other Affiliation: The Children's Hospital of Philadelphia
  • Hebson, C.
    • Other Affiliation: University of Alabama at Birmingham
  • Jain, S.S.
    • Other Affiliation: New York Medical College
  • Johnston, P.
    • Affiliation: University of North Carolina at Chapel Hill
  • Krishnan, A.
    • Other Affiliation: Children's National Hospital
  • Lombardi, K.C.
    • Other Affiliation: Warren Alpert Medical School of Brown University
  • McCrindle, B.W.
    • Other Affiliation: University of Toronto
  • Mitchell, E.C.
    • Other Affiliation: Cohen Children's Medical Center (Northwell Health)
  • Miyata, K.
    • Other Affiliation: University of California San Diego
  • Mizzi, T.
    • Other Affiliation: University of Toronto
  • Parker, R.M.
    • Other Affiliation: Connecticut Children's
  • Patel, J.K.
    • Other Affiliation: Riley Children's Hospital
  • Ronai, C.
    • Other Affiliation: Oregon Health and Science University
  • Sabati, A.A.
    • Other Affiliation: Phoenix Children's Hospital
  • Schauer, J.
    • Other Affiliation: University of Washington
  • Tejtel, S.K.S.
    • Other Affiliation: Texas Children's Hospital
  • Shea, J.R.
    • Other Affiliation: University of North Carolina at Chapel Hill
  • Shekerdemian, L.S.
    • Other Affiliation: Texas Children's Hospital
  • Srivastava, S.
    • Other Affiliation: Nemours Children's Health
  • Votava-Smith, J.K.
    • Other Affiliation: Children's Hospital Los Angeles
  • White, S.
    • Other Affiliation: Children's Hospital Los Angeles
  • Newburger, J.W.
    • Other Affiliation: Boston Children's Hospital
Abstract
  • BACKGROUND: Understanding the clinical course and short-term outcomes of suspected myocarditis after the coronavirus disease 2019 (COVID-19) vaccination has important public health implications in the decision to vaccinate youth. METHODS: We retrospectively collected data on patients <21 years old presenting before July 4, 2021, with suspected myocarditis within 30 days of COVID-19 vaccination. Lake Louise criteria were used for cardiac MRI findings. Myocarditis cases were classified as confirmed or probable on the basis of the Centers for Disease Control and Prevention definitions. RESULTS: We report on 139 adolescents and young adults with 140 episodes of suspected myocarditis (49 confirmed, 91 probable) at 26 centers. Most patients were male (n=126, 90.6%) and White (n=92, 66.2%); 29 (20.9%) were Hispanic; and the median age was 15.8 years (range, 12.1-20.3; interquartile range [IQR], 14.5-17.0). Suspected myocarditis occurred in 136 patients (97.8%) after the mRNA vaccine, with 131 (94.2%) after the Pfizer-BioNTech vaccine; 128 (91.4%) occurred after the second dose. Symptoms started at a median of 2 days (range, 0-22; IQR, 1-3) after vaccination. The most common symptom was chest pain (99.3%). Patients were treated with nonsteroidal anti-inflammatory drugs (81.3%), intravenous immunoglobulin (21.6%), glucocorticoids (21.6%), colchicine (7.9%), or no anti-inflammatory therapies (8.6%). Twenty-six patients (18.7%) were in the intensive care unit, 2 were treated with inotropic/vasoactive support, and none required extracorporeal membrane oxygenation or died. Median hospital stay was 2 days (range, 0-10; IQR, 2-3). All patients had elevated troponin I (n=111, 8.12 ng/mL; IQR, 3.50-15.90) or T (n=28, 0.61 ng/mL; IQR, 0.25-1.30); 69.8% had abnormal ECGs and arrhythmias (7 with nonsustained ventricular tachycardia); and 18.7% had left ventricular ejection fraction <55% on echocardiogram. Of 97 patients who underwent cardiac MRI at a median 5 days (range, 0-88; IQR, 3-17) from symptom onset, 75 (77.3%) had abnormal findings: 74 (76.3%) had late gadolinium enhancement, 54 (55.7%) had myocardial edema, and 49 (50.5%) met Lake Louise criteria. Among 26 patients with left ventricular ejection fraction <55% on echocardiogram, all with follow-up had normalized function (n=25). CONCLUSIONS: Most cases of suspected COVID-19 vaccine myocarditis occurring in persons <21 years have a mild clinical course with rapid resolution of symptoms. Abnormal findings on cardiac MRI were frequent. Future studies should evaluate risk factors, mechanisms, and long-term outcomes.
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DOI
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Resource type
  • Article
Rights statement
  • In Copyright
Journal title
  • Circulation
Journal volume
  • 145
Journal issue
  • 5
Page start
  • 345
Page end
  • 356
Language
  • English
Funder
  • Genentech
  • National Institutes of Health, NIH
Publisher
  • Lippincott Williams and Wilkins

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