ABSTRACT
Introduction: On June 2, 2021, 6 case reports of myocarditis after the Pfizer COVID-19 vaccine surfaced. Each case had a cardiac MRI (CMR) study using T2 weighted and delayed gadolinium imaging. CMR was performed for post-vaccine symptoms. Although valuable, these data do not shed light on the prevalence of this post-vaccine occurrence. This study was designed to assess the prevalence of inflammatory heart disease(IHD) in a group of patients who had a CMR after receiving a COVID-19 vaccine. Hypothesis: Evidence of myocarditis may occur on cardiac MRI after all types of COVID-19 vaccine. Methods: From January 1 to June 8, 2021 303 patients underwent a CMR at Sharon Regional Medical Center. The date of vaccination, type of vaccine and COVID testing results and date for each of these patients were ascertained. All patients who were vaccinated prior to the CMR exam constituted the study population. IHD by CMR was defined as abnormality of 2 or more pulse sequences of the Modified Lake Louise Criteria(MLLC) of 2018: T2 STIR, Delayed enhancement after gadolinium, and prolongation of myocardial or pericardial T1 or T2 relaxation times. The number of patients with CMR evidence of IHD was tabulated for Pfizer, Moderna and Johnson&Johnson(J&J) vaccines. Results: Of 303 patients with a CMR during the study period, 77 were vaccinated prior to CMR. The mean time between vaccination and CMR was 41 days. 42 patients had a Pfizer vaccine, 30 had Moderna and 5 received J&J. 10 Pfizer receipants had IHD findings on CMR(24%), as did 7 of Moderna(23%) and 2 of J&J(40%). 13 patients had a positive COVID test prior to vaccination and IHD was present on CMR in 9 patients(69%) in this subgroup, while only 8 of 63(13%) without a positive COVID-19 test before vaccination showed evidence of IHD. Conclusions: Although retrospective, these data provide valuable information about the occurrence of IHD after COVID-19 vaccination using CMR imaging. A similar percentage of patients vaccinated with any of the 3 vaccines appear to subsequently show evidence of IHD on CMR, more so if previously COVID positive. However, evidence of IHD on post-vaccine CMR does not definitively establish causality. CMR exams before and after COVID-19 vaccination using MLLC will be required to prove a cause-effect relationship.
ABSTRACT
Introduction: Recently published data suggests that inflammatory heart disease (IHD) is far more prevalent in COVID-19 patients than initially expected. Specifically, there have been reports of greater than expected right ventricular (RV) involvement in the post COVID-19 recovery period. However, there are no published data comparing RV dysfunction in COVID-19 and non-COVID-19 patient cohorts with IHD. Purpose: This study was designed to assess and compare the prevalence of RV hypokinesis in 2 patient cohorts: patients with COVID-19 related IHD and patients with non-COVID-19 related IHD, based on cardiac MRI findings (CMR). Methods: An institutional cardiac imaging database was queried for all patients with IHD documented by CMR. Inflammatory heart disease was defined as pericarditis and/or myocarditis using the recently modified Lake Louise criteria, including T1 and T2 relaxation mapping. The prevalence of IHD was evaluated in 2 separate patient cohorts, subjects with COVID-19 related IHD and subjects with non-COVID-19 related IHD. Further assessment of these 2 patients cohorts included the presence of RV hypokinesis. A two-tailed Z-test was used for statistical comparison of the presence of IHD and the presence of RV hypokinesis in these 2 patient cohorts. Results: 62 COVID patients and 6782 non-COVID patients were identified in the imaging database. 53 of the 62 COVID patients (85.5%) had evidence of IHD on CMR study. In contrast, 1273 of the 6782 patients (18.8%) had documented IHD detected by CMR. There was a statistically significant difference between the incidence of IHD in the 2 patient groups (p-value <0.00001). Furthermore, of the 53 COVID patients with IHD, 30 (56.6%) showed evidence of RV hypokinesis on CMR. Of the 1273 non- COVID patients with IHD, only 126 (9.9%) showed evidence of RV hypokinesis on CMR. There was a statistically significant difference between the incidence of RV hypokinesis among the 2 groups (p-value <0.00001). Details are provided in Figure 1. Conclusion: These data suggest that the prevalence of IHD in COVID- 19 patients is 4 times greater than in patients with a non-COVID etiology, based on CMR imaging findings. Furthermore, the occurrence of RV hypokinesis is 5 times greater in COVID-19 patients than in IHD patients with a non-COVID etiology, also based on CMR findings. These data suggest that CMR imaging is of value in detecting both IHD and RV dysfunction, which are often difficult to detect with other imaging modalities. (Figure Presented).
ABSTRACT
Introduction: Intuitively, severity of symptoms usually correlates with severity of disease process or disease progression. In this regard, the ACC Sports and Exercise Cardiology Section proposed an algorithm for competitive athletes to assess and manage cardiac injury after COVID- 19 infection based on initial symptoms. However, there are no published, evidence-based data to substantiate this approach. Purpose: This study was designed to assess the correlation between symptoms at the time of initial diagnosis to post-COVID recovery cardiac symptoms and findings on a cardiac MRI study (CMR). It is hypothesized that the initial symptoms at the time of a positive COVID-19 test may not be reliable or sufficient in predicting the severity of post-COVID recovery symptoms or findings on CMR. Methods: An institutional cardiac imaging database was queried for all patients with a positive COVID-19 PCR test, who subsequently underwent a CMR for post-COVID recovery cardiac symptoms. Severity of COVID- 19 symptoms were assessed using a checklist of mild symptoms and more severe symptoms as defined by the Centers for Disease Control, Atlanta GA. Mild symptoms included: fever/chills, cough, fatigue, body aches, headache, loss of taste/smell, sore throat, congestion, and nausea vomiting diarrhea. More severe symptoms included: shortness of breath, chest pain, and confusion. For each patient, prevalence of these symptoms was assessed at the time of initial diagnosis, and then again post-COVID recovery, just prior to the time of CMR. Inflammatory heart disease (IHD) was defined as pericarditis and/or myocarditis using the recently modified Lake Louise criteria, including T1 and T2 relaxation mapping. Results: 58 patients with a positive COVID-19 PCR test were identified, who subsequently underwent a CMR study for evaluation of cardiac symptoms. 36 patients (62%) had no symptoms at the time of initial diagnosis, while 7 patients (12%) had mild symptoms. Lastly, 15 patients (26%) had more severe symptoms at the time of initial diagnosis. All CMR studies were prompted by the subsequent development of shortness of breath or chest pain. Detection rates of IHD in these 3 groups of patients is delineated in Figure 1. A chi-squared test was used to assess any statistically significant differences in the CMR detection rate of IHD based on initial symptoms. There was no significant difference in the likelihood of IHD based on initial COVID symptoms (p-value=0.856). Conclusion: Forty-three of 58 patients (74%) with no/mild symptoms at the time of initial COVID-19 diagnosis developed more severe post-COVID symptoms requiring CMR. In contrast, 15 of 58 patients (26%) with more severe symptoms at the time of initial COVID-19 diagnosis had persistence of these symptoms requiring CMR. These data suggest that the severity of symptoms on initial presentation with COVID-19 does not predict post- COVID recovery symptoms or CMR findings of inflammatory heart disease. (Figure Presented).