Two years post-COVID-19 vaccine myocarditis, 69% had LV ejection fraction ≥50%, biomarkers normalized, but 31% still had fatigue, palpitations, or chest pain.
More than two years after COVID-19 vaccine-associated myocarditis, patients show biochemical recovery but may have mildly impaired left ventricular function and persistent symptoms such as fatigue.
Absolute Event Rate: 0% vs 0%
Abstract Background The long-term effects of myocarditis following mRNA-based COVID-19 vaccination on cardiac function and symptoms remains unknown. Purpose We sought to assess the long-term effects of myocarditis following mRNA-based COVID-19 vaccination on cardiac function, inflammatory biomarkers, and symptoms. Methods Patients admitted with a diagnosis of myocarditis within 50 days post-COVID-19 vaccination from 2021-2022 were identified through national health registries, cross-checked with hospital records, and invited for a follow-up visit two years after their initial hospitalisation for myocarditis. Patients underwent comprehensive echocardiography, biomarker analysis, ECG, eight-zone lung ultrasound (LUS), and a detailed symptom questionnaire, including the Fatigue Assessment Scale (FAS). Results In total, 46 patients diagnosed with COVID-19 vaccine-associated myocarditis were identified and invited through a digital e-letter system. 16 patients accepted the invitation and were included (mean age: 44 years; 50% female). Myocarditis most frequently occurred after the third COVID-19 vaccine dose (N=6, 38%), with 14 patients (88%) developing myocarditis within 30 days post-vaccination. The median time since admission was 2.4 years (IQR: 2.3–2.7). At follow-up, 11 (69%) patients had a left ventricular (LV) ejection fraction of ≥50% (mean: 50.1±8.9%), compared to 14 (88%) at admission. Mean global longitudinal strain was −12% (±3.2). LV mass index was normal in 13 (81%) patients (median: 111.7 g/m², IQR: 87.4–150.5), and no significant valvular abnormalities were observed. Diastolic function, assessed based on ASE criteria, was normal in 14 (88%) patients, whereas right ventricular function was preserved in all patients (mean TAPSE: 2.3±0.6 cm). On LUS, patients had a mean of 1 B-line (±2). Markers of myocardial injury and inflammation normalised from initial admission to follow-up, with significant reductions in Troponin I (median: 581.5 ng/L IQR: 130.3-17544 vs. 2.9 ng/L IQR 2.9-8.8), p0.001 and CRP (11.2 mg/L IQR: 5.5-44.5 vs. 3.9 mg/L IQR 3.9-4.2, p=0.012). At follow-up, mean NT-proBNP was 13.74 pmol/L IQR: 4.0-17.7. The ECGs showed no persistent conduction abnormalities at follow-up. Regarding symptoms, five patients (31%) reported persistent fatigue at follow-up (mean FAS: 26±9), five patients (31%) still experienced palpitations, and four patients (25%) had ongoing chest pain during exercise. Conclusion Our results indicate that more than two years after admission for COVID-19 vaccine-associated myocarditis, patients exhibit impaired left ventricular function but preserved right ventricular function. There were no signs of pulmonary congestion on LUS, and inflammatory and cardiac biomarkers had normalised. Despite biochemical recovery, one-third of patients continued to experience symptoms, highlighting the need for long-term follow-up to address persistent patient-reported concerns and optimise post-myocarditis care.Figure 1:Key Findings and Conclusion
Ramadan et al. (Sat,) reported a other. Two years post-COVID-19 vaccine myocarditis, 69% had LV ejection fraction ≥50%, biomarkers normalized, but 31% still had fatigue, palpitations, or chest pain.