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2.
Med Clin (Barc) ; 159(9): 440-446, 2022 11 11.
Article in English, Spanish | MEDLINE | ID: covidwho-2131855

ABSTRACT

SARS-CoV-2 is currently causing a persistent COVID-19 pandemic, which poses a risk of causing long-term cardiovascular sequels in the population. The viral mechanism of cell infection through the angiotensin 2 converter enzyme receptor and the limited antiviral innate immune response are the suspected causes for a more frequent cardiovascular damage in SARS-CoV-2 infection. Knowledge of the appearance during acute infection of other cardiac conditions beyond the classical myocarditis and pericarditis, the long-term cardiac manifestations (persistent COVID-19), and the increased incidence of myocarditis and pericarditis after vaccination is of special interest in order to offer our patients best practices based on current scientific evidence.


Subject(s)
COVID-19 , Myocarditis , Pericarditis , Humans , SARS-CoV-2 , Pandemics , Angiotensin-Converting Enzyme 2 , Myocarditis/diagnosis , Myocarditis/epidemiology , Myocarditis/etiology
3.
Saudi Med J ; 43(11): 1270-1275, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2119408

ABSTRACT

Heart muscle inflammations were reported following SARS-CoV-2 messenger ribonucleic acid (RNA) vaccination by the Disease Control Centers in America, and cases of these inflammations reported as adverse effects of this COVID-19 vaccine application increased 1000 times since April 2021. A male individual, 18-year-old received vaccination with mRNA-1273 vaccine, and after a while attended the Emergency Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Upon presentation, the patient complained of a history of chest pain, and he had a high troponin level along with new-onset electrocardiogram changes. During his stay in hospital the patient's blood circulation status remained stable, and no evidence of another infectious or immune cases was found. Although these vaccines are a must and very advantageous in fighting COVID-19 and their benefits are far beyond their risks, although it seems that there is a risk of myopericarditis cases. Under such conditions it is essential to rely on early diagnosis for control and deal with the possible cases of morbidity and mortality associated with these conditions.


Subject(s)
COVID-19 Vaccines , COVID-19 , Myocarditis , Adolescent , Humans , Male , 2019-nCoV Vaccine mRNA-1273 , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Inflammation , Myocarditis/etiology , Myocarditis/diagnosis , SARS-CoV-2 , Vaccination
4.
Lancet ; 399(10342): 2191-2199, 2022 06 11.
Article in English | MEDLINE | ID: covidwho-2115496

ABSTRACT

BACKGROUND: Several passive surveillance systems reported increased risks of myocarditis or pericarditis, or both, after COVID-19 mRNA vaccination, especially in young men. We used active surveillance from large health-care databases to quantify and enable the direct comparison of the risk of myocarditis or pericarditis, or both, after mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech) vaccinations. METHODS: We conducted a retrospective cohort study, examining the primary outcome of myocarditis or pericarditis, or both, identified using the International Classification of Diseases diagnosis codes, occurring 1-7 days post-vaccination, evaluated in COVID-19 mRNA vaccinees aged 18-64 years using health plan claims databases in the USA. Observed (O) incidence rates were compared with expected (E) incidence rates estimated from historical cohorts by each database. We used multivariate Poisson regression to estimate the adjusted incidence rates, specific to each brand of vaccine, and incidence rate ratios (IRRs) comparing mRNA-1273 and BNT162b2. We used meta-analyses to pool the adjusted incidence rates and IRRs across databases. FINDINGS: A total of 411 myocarditis or pericarditis, or both, events were observed among 15 148 369 people aged 18-64 years who received 16 912 716 doses of BNT162b2 and 10 631 554 doses of mRNA-1273. Among men aged 18-25 years, the pooled incidence rate was highest after the second dose, at 1·71 (95% CI 1·31 to 2·23) per 100 000 person-days for BNT162b2 and 2·17 (1·55 to 3·04) per 100 000 person-days for mRNA-1273. The pooled IRR in the head-to-head comparison of the two mRNA vaccines was 1·43 (95% CI 0·88 to 2·34), with an excess risk of 27·80 per million doses (-21·88 to 77·48) in mRNA-1273 recipients compared with BNT162b2. INTERPRETATION: An increased risk of myocarditis or pericarditis was observed after COVID-19 mRNA vaccination and was highest in men aged 18-25 years after a second dose of the vaccine. However, the incidence was rare. These results do not indicate a statistically significant risk difference between mRNA-1273 and BNT162b2, but it should not be ruled out that a difference might exist. Our study results, along with the benefit-risk profile, continue to support vaccination using either of the two mRNA vaccines. FUNDING: US Food and Drug Administration.


Subject(s)
2019-nCoV Vaccine mRNA-1273 , BNT162 Vaccine , COVID-19 , Myocarditis , Pericarditis , 2019-nCoV Vaccine mRNA-1273/adverse effects , Adolescent , Adult , BNT162 Vaccine/adverse effects , COVID-19/epidemiology , COVID-19/prevention & control , Cohort Studies , Humans , Male , Myocarditis/diagnosis , Myocarditis/epidemiology , Myocarditis/etiology , Pericarditis/diagnosis , Pericarditis/epidemiology , Pericarditis/etiology , Retrospective Studies , Vaccination/adverse effects , Young Adult
5.
Can J Cardiol ; 38(11): 1693-1696, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2114257
7.
J Am Heart Assoc ; 11(9): e024393, 2022 05 03.
Article in English | MEDLINE | ID: covidwho-2108433

ABSTRACT

Background Although rare, classic viral myocarditis in the pediatric population is a disease that carries significant morbidity and mortality. Since 2020, myocarditis has been a common component of multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection. In 2021, myocarditis related to mRNA COVID-19 vaccines was recognized as a rare adverse event. This study aims to compare classic, MIS-C, and COVID-19 vaccine-related myocarditis with regard to clinical presentation, course, and outcomes. Methods and Results In this retrospective cohort study, we compared patients aged <21 years hospitalized at our institution with classic viral myocarditis from 2015 to 2019, MIS-C myocarditis from March 2020 to February 2021, and vaccine-related myocarditis from May 2021 to June 2021. Of 201 total participants, 43 patients had classic myocarditis, 149 had MIS-C myocarditis, and 9 had vaccine-related myocarditis. At presentation, ejection fraction was lowest for those with classic myocarditis, with ejection fraction <55% present in 58% of patients. Nearly all patients with MIS-C myocarditis (n=139, 93%) and all patients with vaccine-related myocarditis (n=9, 100%) had normal left ventricular ejection fraction at the time of discharge compared with 70% (n=30) of the classic myocarditis group (P<0.001). At 3 months after discharge, of the 21 children discharged with depressed ejection fraction, none of the 10 children with MIS-C myocarditis had residual dysfunction compared with 3 of the 11 (27%) patients in the classic myocarditis group. Conclusions Compared with classic myocarditis, those with MIS-C myocarditis had better clinical outcomes, including rapid recovery of cardiac function. Patients with vaccine-related myocarditis had prompt resolution of symptoms and improvement of cardiac function.


Subject(s)
COVID-19 , Myocarditis , COVID-19/complications , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Child , Humans , Myocarditis/chemically induced , Myocarditis/diagnosis , Myocarditis/epidemiology , Retrospective Studies , SARS-CoV-2 , Stroke Volume , Systemic Inflammatory Response Syndrome , Ventricular Function, Left
8.
Lancet Child Adolesc Health ; 6(11): 788-798, 2022 11.
Article in English | MEDLINE | ID: covidwho-2096191

ABSTRACT

BACKGROUND: Data on medium-term outcomes in indivduals with myocarditis after mRNA COVID-19 vaccination are scarce. We aimed to assess clinical outcomes and quality of life at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults. METHODS: In this follow-up surveillance study, we conducted surveys in US individuals aged 12-29 years with myocarditis after mRNA COVID-19 vaccination, for whom a report had been filed to the Vaccine Adverse Event Reporting System between Jan 12 and Nov 5, 2021. A two-component survey was administered, one component to patients (or parents or guardians) and one component to health-care providers, to assess patient outcomes at least 90 days since myocarditis onset. Data collected were recovery status, cardiac testing, and functional status, and EuroQol health-related quality-of-life measures (dichotomised as no problems or any problems), and a weighted quality-of-life measure, ranging from 0 to 1 (full health). The EuroQol results were compared with published results in US populations (aged 18-24 years) from before and early on in the COVID-19 pandemic. FINDINGS: Between Aug 24, 2021, and Jan 12, 2022, we collected data for 519 (62%) of 836 eligible patients who were at least 90 days post-myocarditis onset: 126 patients via patient survey only, 162 patients via health-care provider survey only, and 231 patients via both surveys. Median patient age was 17 years (IQR 15-22); 457 (88%) patients were male and 61 (12%) were female. 320 (81%) of 393 patients with a health-care provider assessment were considered recovered from myocarditis by their health-care provider, although at the last health-care provider follow-up, 104 (26%) of 393 patients were prescribed daily medication related to myocarditis. Of 249 individuals who completed the quality-of-life portion of the patient survey, four (2%) reported problems with self-care, 13 (5%) with mobility, 49 (20%) with performing usual activities, 74 (30%) with pain, and 114 (46%) with depression. Mean weighted quality-of-life measure (0·91 [SD 0·13]) was similar to a pre-pandemic US population value (0·92 [0·13]) and significantly higher than an early pandemic US population value (0·75 [0·28]; p<0·0001). Most patients had improvements in cardiac diagnostic marker and testing data at follow-up, including normal or back-to-baseline troponin concentrations (181 [91%] of 200 patients with available data), echocardiograms (262 [94%] of 279 patients), electrocardiograms (240 [77%] of 311 patients), exercise stress testing (94 [90%] of 104 patients), and ambulatory rhythm monitoring (86 [90%] of 96 patients). An abnormality was noted among 81 (54%) of 151 patients with follow-up cardiac MRI; however, evidence of myocarditis suggested by the presence of both late gadolinium enhancement and oedema on cardiac MRI was uncommon (20 [13%] of 151 patients). At follow-up, most patients were cleared for all physical activity (268 [68%] of 393 patients). INTERPRETATION: After at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination, most individuals in our cohort were considered recovered by health-care providers, and quality of life measures were comparable to those in pre-pandemic and early pandemic populations of a similar age. These findings might not be generalisable given the small sample size and further follow-up is needed for the subset of patients with atypical test results or not considered recovered. FUNDING: US Centers for Disease Control and Prevention.


Subject(s)
COVID-19 , Myocarditis , Adolescent , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Contrast Media , Female , Follow-Up Studies , Gadolinium , Humans , Male , Myocarditis/diagnosis , Myocarditis/epidemiology , Myocarditis/etiology , Pandemics , Quality of Life , RNA, Messenger , Troponin , United States/epidemiology , Vaccination , Young Adult
9.
J Am Coll Cardiol ; 80(20): 1900-1908, 2022 Nov 15.
Article in English | MEDLINE | ID: covidwho-2095536

ABSTRACT

BACKGROUND: Postmarketing evaluations have linked myocarditis to COVID-19 mRNA vaccines. However, few population-based analyses have directly compared the safety of the 2 mRNA COVID-19 vaccines. OBJECTIVES: This study aimed to compare the risk of myocarditis, pericarditis, and myopericarditis between BNT162b2 and mRNA-1273. METHODS: We used data from the British Columbia COVID-19 Cohort (BCC19C), a population-based cohort study. The exposure was the second dose of an mRNA vaccine. The outcome was diagnosis of myocarditis, pericarditis, or myopericarditis during a hospitalization or an emergency department visit within 21 days of the second vaccination dose. We performed multivariable logistic regression to assess the association between vaccine product and the outcomes of interest. RESULTS: The rates of myocarditis and pericarditis per million second doses were higher for mRNA-1273 (n = 31, rate 35.6; 95% CI: 24.1-50.5; and n = 20, rate 22.9; 95% CI: 14.0-35.4, respectively) than BNT162b2 (n = 28, rate 12.6; 95% CI: 8.4-18.2 and n = 21, rate 9.4; 95% CI: 5.8-14.4, respectively). mRNA-1273 vs BNT162b2 had significantly higher odds of myocarditis (adjusted OR [aOR]: 2.78; 95% CI: 1.67-4.62), pericarditis (aOR: 2.42; 95% CI: 1.31-4.46) and myopericarditis (aOR: 2.63; 95% CI: 1.76-3.93). The association between mRNA-1273 and myocarditis was stronger for men (aOR: 3.21; 95% CI: 1.77-5.83) and younger age group (18-39 years; aOR: 5.09; 95% CI: 2.68-9.66). CONCLUSIONS: Myocarditis/pericarditis following mRNA COVID-19 vaccines is rare, but we observed a 2- to 3-fold higher odds among individuals who received mRNA-1273 vs BNT162b2. The rate of myocarditis following mRNA-1273 receipt is highest among younger men (age 18-39 years) and does not seem to be present at older ages. Our findings may have policy implications regarding the choice of vaccine offered.


Subject(s)
COVID-19 Vaccines , COVID-19 , Myocarditis , Pericarditis , Adolescent , Adult , Humans , Male , Young Adult , 2019-nCoV Vaccine mRNA-1273 , BNT162 Vaccine , Cohort Studies , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Myocarditis/epidemiology , Myocarditis/etiology , Myocarditis/diagnosis , Pericarditis/epidemiology , Pericarditis/etiology , Pericarditis/diagnosis , Vaccination , Vaccines
10.
WMJ ; 121(3): E50-E52, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2092677

ABSTRACT

INTRODUCTION: We present a case report highlighting a single patient out of 3 who developed myocarditis within days after receiving Pfizer and Moderna COVID-19 mRNA vaccines. CASE PRESENTATION: A 19-year-old male was admitted to our hospitalist service with substernal chest pain that was sharp, constant, and varied with position. He had received his second dose of the Pfizer-BioNTech COVID-19 vaccine (Pfizer vaccine) 2 days prior. Electrocardiogram was consistent with pericarditis. He had persistently elevated troponins and globally reduced systolic function by echocardiogram, which was consistent with myocarditis. He received colchicine, ibuprofen, and proton pump inhibitors with a resolution of symptoms. After 32 days, follow-up echocardiogram had returned to normal, and his symptoms had resolved completely. DISCUSSION: Given the onset of symptoms after the second dose of vaccine and our review of similar cases in the literature, it seems likely the patient's myopericarditis was caused by the vaccine. Rare complications of new vaccines given to millions of people are rapidly identified by the Vaccine Adverse Event Reporting System. CONCLUSIONS: The identification of myopericarditis as a complication of mRNA vaccines will need further study to understand the pathophysiology, incidence, and prevalence in specific age groups and biological sexes.


Subject(s)
COVID-19 Vaccines , COVID-19 , Myocarditis , Adult , Humans , Male , Young Adult , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Myocarditis/chemically induced , Myocarditis/diagnosis
13.
WMJ ; 121(3): E50-E52, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2083848

ABSTRACT

INTRODUCTION: We present a case report highlighting a single patient out of 3 who developed myocarditis within days after receiving Pfizer and Moderna COVID-19 mRNA vaccines. CASE PRESENTATION: A 19-year-old male was admitted to our hospitalist service with substernal chest pain that was sharp, constant, and varied with position. He had received his second dose of the Pfizer-BioNTech COVID-19 vaccine (Pfizer vaccine) 2 days prior. Electrocardiogram was consistent with pericarditis. He had persistently elevated troponins and globally reduced systolic function by echocardiogram, which was consistent with myocarditis. He received colchicine, ibuprofen, and proton pump inhibitors with a resolution of symptoms. After 32 days, follow-up echocardiogram had returned to normal, and his symptoms had resolved completely. DISCUSSION: Given the onset of symptoms after the second dose of vaccine and our review of similar cases in the literature, it seems likely the patient's myopericarditis was caused by the vaccine. Rare complications of new vaccines given to millions of people are rapidly identified by the Vaccine Adverse Event Reporting System. CONCLUSIONS: The identification of myopericarditis as a complication of mRNA vaccines will need further study to understand the pathophysiology, incidence, and prevalence in specific age groups and biological sexes.


Subject(s)
COVID-19 Vaccines , COVID-19 , Myocarditis , Adult , Humans , Male , Young Adult , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Myocarditis/chemically induced , Myocarditis/diagnosis
16.
J Cardiovasc Med (Hagerstown) ; 23(12): 779-783, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2054847

ABSTRACT

AIMS: Vaccination represents a cornerstone of prevention in the COVID-19 pandemic. Rare adverse events including acute pericarditis and myopericarditis have been reported. METHODS: All consecutive patients referred to our referral center for pericardial diseases following COVID-19 vaccination from 1 April 2021 to 15 April 2022 were included. Acute pericarditis and myopericarditis were diagnosed according to ESC guidelines. Patients with SARS-CoV-2 infection were excluded from the study. RESULTS: Twenty-four patients (79% men) aged 39.7 ±â€Š19.8 years were referred to our center with pericarditis after receiving COVID-19 vaccination. Thirteen (54%) patients were diagnosed with myopericarditis. The mean time between vaccination and symptoms onset was 7.0 ±â€Š4.9 days, and the most frequent symptom was pericarditic chest pain (83%). Respectively, 50 and 33% of patients presented after the second and the third dose of the vaccine. Almost all patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine. Five patients (21%) experienced a recurrence of pericarditis. No patient died or developed constrictive pericarditis. Mean follow-up was 8.0 ±â€Š3.2 months. CONCLUSION: COVID-19 vaccine-related pericarditis typically manifest with mild clinical signs, in young male individuals, a few days after the second or third vaccine dose and are commonly characterized by a rapid complete recovery.


Subject(s)
COVID-19 , Myocarditis , Pericarditis , Humans , Male , Female , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Pandemics , SARS-CoV-2 , Pericarditis/chemically induced , Pericarditis/diagnosis , Myocarditis/diagnosis , Vaccination/adverse effects
17.
Emerg Microbes Infect ; 11(1): 2466-2473, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2051170

ABSTRACT

In this study, we examined the clinical and electrophysiological outcomes of adolescents in Hong Kong who developed myocarditis or pericarditis following BNT162b2 vaccination for COVID-19, and followed-up for 60-180 days after their initial diagnosis. Clinical assessments included electrocardiogram (ECG) and echocardiogram at the initial admission and follow-up were compared. Treadmill testing was also performed in some cases. Between 14 June 2021 and 16 February 2022, 53 subjects were approached to participate in this follow-up study, of which 28 patients were followed up for >60 days with a median follow-up period of 100 days (range, 61-178 days) and were included in this study. On admission, 23 patients had ECG abnormalities but no high-grade atrioventricular block. Six patients had echocardiogram abnormalities, including reduced contractility, small rim pericardial effusions, and hyperechoic ventricular walls. All patients achieved complete recovery on follow-up. After discharge, 10 patients (35.7%) reported symptoms, including occasional chest pain, shortness of breath, reduced exercise tolerance, and recurrent vasovagal near-syncope. At follow-up, assessments, including ECGs, were almost all normal. Among the three patients with possible ECG abnormalities, all their echocardiograms or treadmill testings were normal. Sixteen patients (57.1%) underwent treadmill testing at a median of 117 days post-admission, which were also normal. However, at follow-up, there was a significant mean bodyweight increase of 1.81 kg (95%CI 0.47-3.1 kg, p = 0.01), possibly due to exercise restriction. In conclusion, most adolescents experiencing myocarditis and pericarditis following BNT162b2 vaccination achieved complete recovery. Some patients developed non-specific persistent symptoms, and bodyweight changes shall be monitored.


Subject(s)
BNT162 Vaccine , COVID-19 , Myocarditis , Pericarditis , Adolescent , Humans , BNT162 Vaccine/adverse effects , COVID-19/prevention & control , Follow-Up Studies , Hong Kong/epidemiology , Myocarditis/diagnosis , Myocarditis/etiology , Pericarditis/diagnosis , Pericarditis/etiology , Vaccination/adverse effects
20.
Can J Cardiol ; 38(11): 1676-1683, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2035864

ABSTRACT

BACKGROUND: Acute myocarditis is a rare complication of mRNA-based COVID-19 vaccination. Little is known about the natural history of this complication. METHODS: Baseline and convalescent (≥ 90 days) cardiac magnetic resonance (CMR) imaging assessments were performed in 20 consecutive patients meeting Updated Lake Louise Criteria for acute myocarditis within 10 days of mRNA-based vaccination. CMR-based changes in left ventricular volumes, mass, ejection fraction (LVEF), markers of tissue inflammation (native T1 and T2 mapping), and fibrosis (late gadolinium enhancement [LGE] and extracellular volume [ECV]) were assessed between baseline and convalescence. Cardiac symptoms and clinical outcomes were captured. RESULTS: Median age was 23.1 years (range 18-39 years), and 17 (85%) were male. Convalescent evaluations were performed at a median (IQR) 3.7 (3.3-6.2) months. The LVEF showed a mean 3% absolute improvement, accompanied by a 7% reduction in LV end-diastolic volume and 5% reduction in LV mass (all P < 0.015). Global LGE burden was reduced by 66% (P < 0.001). Absolute reductions in global T2, native T1, and ECV of 2.1 ms, 58 ms, and 2.9%, repectively, were documented (all P ≤ 0.001). Of 5 patients demonstrating LVEF ≤ 50% at baseline, all recovered to above this threshold in convalescence. A total of 18 (90%) patients showed persistence of abnormal LGE although mean fibrosis burden was < 5% of LV mass in 85% of cases. No patient experienced major clinical outcomes. CONCLUSIONS: COVID-19 mRNA vaccine-associated myocarditis showed rapid improvements in CMR-based markers of edema, contractile function, and global LGE burden beyond 3 months of recovery in this young patient cohort. However, regional fibrosis following edema resolution was commonly observed, justifying need for ongoing surveillance.


Subject(s)
COVID-19 , Heart Injuries , Myocarditis , Humans , Male , Adolescent , Young Adult , Adult , Female , Myocarditis/diagnosis , Myocarditis/etiology , Myocarditis/pathology , COVID-19 Vaccines/adverse effects , Contrast Media , Gadolinium , COVID-19/epidemiology , COVID-19/prevention & control , Convalescence , Ventricular Function, Left , Stroke Volume , Predictive Value of Tests , Fibrosis , RNA, Messenger , Magnetic Resonance Imaging, Cine , Myocardium/pathology
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