Endomyocardial biopsy revealed myocardial inflammation in 14 of 15 patients (93.3%) with suspected myocarditis following COVID-19 vaccination, suggesting an autoimmunological response.
Observational (n=15)
What are the histopathological findings in endomyocardial biopsies of patients with suspected myocarditis following COVID-19 vaccination?
Endomyocardial biopsy of patients with suspected myocarditis after COVID-19 vaccination revealed myocardial inflammation in 14 of 15 cases, with findings suggesting an autoimmunological response.
Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular, young male individuals have been identified to exhibit an increased risk of myocardial inflammation following the administration of mRNA-based vaccines. Even though the first epidemiological analyses and numerous case reports investigated potential relationships, endomyocardial biopsy (EMB)-proven cases are limited. Here, we present a comprehensive histopathological analysis of EMBs from 15 patients with reduced ejection fraction (LVEF = 30 (14–39)%) and the clinical suspicion of myocarditis following vaccination with Comirnaty® (Pfizer-BioNTech) (n = 11), Vaxzevria® (AstraZenica) (n = 2) and Janssen® (Johnson & Johnson) (n = 2). Immunohistochemical EMB analyses reveal myocardial inflammation in 14 of 15 patients, with the histopathological diagnosis of active myocarditis according the Dallas criteria (n = 2), severe giant cell myocarditis (n = 2) and inflammatory cardiomyopathy (n = 10). Importantly, infectious causes have been excluded in all patients. The SARS-CoV-2 spike protein has been detected sparsely on cardiomyocytes of nine patients, and differential analysis of inflammatory markers such as CD4+ and CD8+ T cells suggests that the inflammatory response triggered by the vaccine may be of autoimmunological origin. Although a definitive causal relationship between COVID-19 vaccination and the occurrence of myocardial inflammation cannot be demonstrated in this study, data suggest a temporal connection. The expression of SARS-CoV-2 spike protein within the heart and the dominance of CD4+ lymphocytic infiltrates indicate an autoimmunological response to the vaccination.
Baumeier et al. (Wed,) conducted a observational in Suspected myocarditis following COVID-19 vaccination (n=15). COVID-19 vaccination was evaluated on Myocardial inflammation on endomyocardial biopsy. Endomyocardial biopsy revealed myocardial inflammation in 14 of 15 patients (93.3%) with suspected myocarditis following COVID-19 vaccination, suggesting an autoimmunological response.
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