Key result
Patients with suspected acute myocarditis following mRNA COVID-19 vaccination demonstrated significantly prolonged T1 relaxation times and subepicardial late gadolinium enhancement on cardiac MRI.
Why the study?
To evaluate cardiac MRI characteristics in patients with suspected hypersensitivity myocarditis following mRNA COVID-19 vaccination.
Does cardiac MRI identify characteristics of hypersensitivity myocarditis in patients with suspected acute myocarditis after COVID-19 mRNA vaccination?
Observational (n=60)
Single-blind
No
Does cardiac MRI identify characteristics of hypersensitivity myocarditis in patients with suspected acute myocarditis after COVID-19 mRNA vaccination?
Absolute Event Rate: 1041% vs 970%
p-value: p=<0.001
Cardiac MRI can effectively confirm vaccine-induced hypersensitivity myocarditis, which presents with imaging characteristics similar to virus-induced myocarditis, particularly in patients with sudden symptom onset and elevated troponin T.
Supports CMR evaluation of suspected post-vaccination myocarditis; leaves open causality and outcomes from Level 4 data.
PURPOSE: To evaluate cardiac MRI characteristics in patients with suspected hypersensitivity myocarditis following mRNA COVID-19 vaccination. MATERIALS AND METHODS: test were used for statistical analysis. RESULTS: 20 patients with clinically suspected post-vaccine myocarditis (28 ± 12 years; 12 men) and 40 controls (31 ± 11 years; 25 men) were evaluated. According to the 2018 Lake Louise criteria (LLC), patients with clinically suspected myocarditis were further subdivided into an LLC-positive group (n = 9) and an LLC-negative group (n = 11). The mean time of symptom onset after vaccination was 1.1 ± 1.2 days (LLC-positive) and 6.5 ± 9.2 days (LLC-negative). Group differences in inflammatory variables between myocarditis patients and control subjects were more pronounced in the LLC-positive group (e. g., T1 relaxation time: 1041 ± 61 ms [LLC positive] vs. 1008 ± 79 ms [LLC-negative] vs. 970 ± 25 ms [control]; p <.001; or T2 signal intensity ratio 2.0 ± 0.3 vs. 1.6 ± 0.3 [LLC-negative] and vs. 1.6 ± 0.3 [control], p = .012). LLC-positive patients were significantly faster in receiving an MRI after initial symptom onset (8.8 ± 6.1 days vs. 52.7 ± 33.4 days; p = .001) and had higher troponin T levels (3938 ± 5850 ng/l vs. 9 ± 11 ng/l; p <.001). LGE lesions were predominantly located at the subepicardium of the lateral wall. Axillary lymphadenopathy was more frequent in the LLC-positive group compared to the LLC-negative group (8/9 [89 %] vs. 0/11 [0 %], p < 0.001). CONCLUSION: Vaccine-induced myocarditis should be considered in patients with acute symptom onset after mRNA vaccination, especially if elevated serum troponin T is observed. Imaging findings of vaccine-induced myocarditis are similar to virus-induced myocarditis, allowing for the use of the Lake Louise Criteria for diagnostic purposes. KEY POINTS: · Vaccine-induced hypersensitivity myocarditis can be confirmed with cardiac MRI. · Especially patients with sudden onset of symptoms and elevated serum troponin T had positive cardiac MRI findings. · Cardiac MRI characteristics of vaccine-induced myocarditis are similar to those in virus-induced myocarditis. CITATION FORMAT: · Kravchenko D, Isaak A, Mesropyan N et al. Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination. Fortschr Röntgenstr 2022; 194: 1003 - 1011.
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Kravchenko et al. (2022) conducted an observational in Suspected acute myocarditis after COVID-19 mRNA vaccination (n=60). mRNA COVID-19 vaccination vs. Healthy controls was evaluated on Myocardial T1 relaxation time (ms) (p=<0.001). Patients with suspected acute myocarditis following mRNA COVID-19 vaccination demonstrated significantly prolonged T1 relaxation times and subepicardial late gadolinium enhancement on cardiac MRI.
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