Cardiac magnetic resonance follow-up of COVID-19 vaccine associated acute myocarditis

Figures

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  FIGURE 1. Late gadolinium enhancement (LGE) distribution on CMR in patients suffering from vaccine associated myocarditis at acute baseline imaging and at follow-up according to the American Heart Association 17-segment heart model. LGE extent was reduced on follow-up imaging, although LGE findings were still discernable at most previous locations.

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  FIGURE 2. Baseline and follow-up cardiac imaging in a 25-year-old male with acute vaccine associated myocarditis after receiving his second vaccine with Pfizer/BioNTech. Short-axis and 4-chamber late gadolinium enhancement (LGE) views demonstrate subepicardial enhancement along the midventricular and apical inferolateral wall (arrows). T2 short-axis short tau inversion recovery (STIR) imaging corresponding to the LGE findings shows a resolution of edema from baseline to follow-up (arrow). Normalization of T1 and T2 relaxation times are also demonstrated over time (arrow). Note, however, the persistent LGE along the inferolateral wall even at follow-up, consistent with scar tissue.

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  FIGURE 3. Short-axis and 4-chamber late gadolinium enhancement (LGE) views in a 28-year-old, previously healthy male after receiving his second Moderna vaccine. Reduction of subepicardial enhancement along the lateral wall from baseline (arrows) to follow-up 11-months later consistent with myocardial scarring. This patient reported new onset of occasional exertional dyspnea after initial acute vaccine associated myocarditis.

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  FIGURE 4. Short-axis and 4-chamber late gadolinium enhancement (LGE) views in a 26-year-old, previously healthy female after receiving the first dose of the Pfizer/BioNTech vaccine. Nearly complete resolution of LGE (arrows) at follow-up 2 months later with minor enhancement discernable at the apical lateral segment. Clinical correlation showed a complete resolution of previous symptoms which included chest pain and exertional dyspnea.

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  FIGURE 5. 4-chamber late gadolinium enhancement (LGE) views of a 36-year-old, previously healthy male after receiving the third dose of the Pfizer/BioNTech vaccine. The LGE lesion at the apical lateral wall (arrow) reduced at follow-up 3 months later, but was still visible, a finding which is consistent with scar tissue. Patient reported complete resolution of clinical symptoms which included chest pain and palpitations.

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  FIGURE 6. Short-axis late gadolinium enhancement (LGE) and short-axis T2 short tau inversion recovery (STIR) views of a 24-year-old, previously healthy male after receiving the second dose of the Pfizer/BioNTech vaccine. LGE at the basal inferolateral wall (thin arrows) shows a marked decrease at 6-month follow-up, with only minimal remaining findings. T2 STIR imaging shows focal myocardial edema corresponding to the location of the LGE (thick arrows) with complete resolution at follow-up. The patient reported complete resolution of previous clinical symptoms but complained of new onset exertional dyspnea.

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  FIGURE 7. 4-chamber and short-axis late gadolinium enhancement (LGE) views of a 15-year-old male after receiving the second dose of the Pfizer/BioNTech vaccine. Subepicardial and pericardial LGE at the apical lateral wall (arrows) shows a marked decrease at the 9-month follow-up with residual findings. Resolution of chest pain at follow-up was accompanied by new onset of occasional exertional dyspnea.