Among 7 patients identified with acute myocarditis over a 3-month period, 4 had received a second dose of an mRNA COVID-19 vaccine within the preceding 5 days.
Observational (n=7)
No
Is mRNA COVID-19 vaccination associated with the occurrence of acute myocarditis?
This case series provides early observational evidence of a potential association between mRNA COVID-19 vaccination and acute myocarditis, characterized by typical cardiovascular magnetic resonance imaging findings.
Importance: Vaccine-associated myocarditis is an unusual entity that has been described for the smallpox vaccine, but only anecdotal case reports have been described for other vaccines. Whether COVID-19 vaccination may be linked to the occurrence of myocarditis is unknown. Objective: To describe a group of 7 patients with acute myocarditis over 3 months, 4 of whom had recent messenger RNA (mRNA) COVID-19 vaccination. Design, Setting, and Participants: All patients referred for cardiovascular magnetic resonance imaging at Duke University Medical Center were asked to participate in a prospective outcomes registry. Two searches of the registry database were performed: first, to identify patients with acute myocarditis for the 3-month period between February 1 and April 30 for 2017 through 2021, and second, to identify all patients with possible vaccine-associated myocarditis for the past 20 years. Once patients with possible vaccine-associated myocarditis were identified, data available in the registry were supplemented by additional data collection from the electronic health record and a telephone interview. Exposures: mRNA COVID-19 vaccine. Main Outcomes and Measures: Occurrence of acute myocarditis by cardiovascular magnetic resonance imaging. Results: In the 3-month period between February 1 and April 30, 2021, 7 patients with acute myocarditis were identified, of which 4 occurred within 5 days of COVID-19 vaccination. Three were younger male individuals (age, 23-36 years) and 1 was a 70-year-old female individual. All 4 had received the second dose of an mRNA vaccine (2 received mRNA-1273 Moderna, and 2 received BNT162b2 Pfizer). All presented with severe chest pain, had biomarker evidence of myocardial injury, and were hospitalized. Coincident testing for COVID-19 and respiratory viruses provided no alternative explanation. Cardiac magnetic resonance imaging findings were typical for myocarditis, including regional dysfunction, late gadolinium enhancement, and elevated native T1 and T2. Conclusions and Relevance: In this study, magnetic resonance imaging findings were found to be consistent with acute myocarditis in 7 patients; 4 of whom had preceding COVID-19 vaccination. Further investigation is needed to determine associations of COVID-19 vaccination and myocarditis.
Kim et al. (Tue,) conducted a observational in Acute myocarditis (n=7). mRNA COVID-19 vaccine was evaluated on Occurrence of acute myocarditis by cardiovascular magnetic resonance imaging. Among 7 patients identified with acute myocarditis over a 3-month period, 4 had received a second dose of an mRNA COVID-19 vaccine within the preceding 5 days.