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Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination.
Truong, Dongngan T; Dionne, Audrey; Muniz, Juan Carlos; McHugh, Kimberly E; Portman, Michael A; Lambert, Linda M; Thacker, Deepika; Elias, Matthew D; Li, Jennifer S; Toro-Salazar, Olga H; Anderson, Brett R; Atz, Andrew M; Bohun, C Monique; Campbell, M Jay; Chrisant, Maryanne; D'Addese, Laura; Dummer, Kirsten B; Forsha, Daniel; Frank, Lowell H; Frosch, Olivia H; Gelehrter, Sarah K; Giglia, Therese M; Hebson, Camden; Jain, Supriya S; Johnston, Pace; Krishnan, Anita; Lombardi, Kristin C; McCrindle, Brian W; Mitchell, Elizabeth C; Miyata, Koichi; Mizzi, Trent; Parker, Robert M; Patel, Jyoti K; Ronai, Christina; Sabati, Arash A; Schauer, Jenna; Sexson Tejtel, S Kristen; Shea, J Ryan; Shekerdemian, Lara S; Srivastava, Shubhika; Votava-Smith, Jodie K; White, Sarah; Newburger, Jane W.
  • Truong DT; Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., L.M.L.).
  • Dionne A; Department of Cardiology, Boston Children's Hospital, Department of Pediatrics; Harvard Medical School, MA (A.D., J.W.N.).
  • Muniz JC; Nicklaus Children's Hospital, Miami, FL (J.C.M.).
  • McHugh KE; Department of Pediatrics, Medical University of South Carolina, Charleston (K.E.M., A.M.A.).
  • Portman MA; Seattle Children's, Department of Pediatrics, University of Washington (M.A.P., J.S.).
  • Lambert LM; Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., L.M.L.).
  • Thacker D; Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE (D.T., S.S.).
  • Elias MD; Division of Cardiology, The Children's Hospital of Philadelphia, PA (M.D.E., T.M.G.).
  • Li JS; Duke University School of Medicine, Durham, NC (J.S.L., M.J.C.).
  • Toro-Salazar OH; Connecticut Children's Medical Center and University of Connecticut School of Medicine, Farmington (O.H.T.-S.).
  • Anderson BR; Division of Pediatric Cardiology; NewYork-Presbyterian/Columbia University Irving Medical Center (B.R.A.).
  • Atz AM; Department of Pediatrics, Medical University of South Carolina, Charleston (K.E.M., A.M.A.).
  • Bohun CM; Oregon Health & Science University, Division of Pediatric Cardiology, Department of Pediatrics, Portland (C.M.B., C.R.).
  • Campbell MJ; Duke University School of Medicine, Durham, NC (J.S.L., M.J.C.).
  • Chrisant M; The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (M.C., L.D.'A.).
  • D'Addese L; The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (M.C., L.D.'A.).
  • Dummer KB; Division of Pediatric Cardiology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego (K.B.D.).
  • Forsha D; Division of Pediatric Cardiology, Children's Mercy, Kansas City, MO (D.F.).
  • Frank LH; Division of Cardiology, Children's National Hospital, Washington, DC (L.H.F., A.K.).
  • Frosch OH; Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (O.H.F., S.K.G.).
  • Gelehrter SK; Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (O.H.F., S.K.G.).
  • Giglia TM; Division of Cardiology, The Children's Hospital of Philadelphia, PA (M.D.E., T.M.G.).
  • Hebson C; Children's of Alabama Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham School of Medicine (C.H.).
  • Jain SS; Maria Fareri Children's Hospital at Westchester Medical Center/New York Medical College, Valhalla (S.S.J.).
  • Johnston P; University of North Carolina at Chapel Hill (P.J., J.R.S.).
  • Krishnan A; Division of Cardiology, Children's National Hospital, Washington, DC (L.H.F., A.K.).
  • Lombardi KC; Warren Alpert Medical School of Brown University; Division of Pediatric Cardiology, Hasbro Children's Hospital, Providence, RI (K.C.L.).
  • McCrindle BW; Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (B.W.M., T.M.).
  • Mitchell EC; Cohen Children's Medical Center (Northwell Health), New Hyde Park, NY (E.C.M.).
  • Miyata K; Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego, La Jolla and Rady Children's Hospital San Diego (K.M.).
  • Mizzi T; Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (B.W.M., T.M.).
  • Parker RM; Division of Critical Care, Connecticut Children's, Hartford (R.M.P.).
  • Patel JK; Division of Pediatric Cardiology, Riley Children's Hospital, Indianapolis, IN (J.K.P.).
  • Ronai C; Oregon Health & Science University, Division of Pediatric Cardiology, Department of Pediatrics, Portland (C.M.B., C.R.).
  • Sabati AA; Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.A.S.).
  • Schauer J; Seattle Children's, Department of Pediatrics, University of Washington (M.A.P., J.S.).
  • Sexson Tejtel SK; Baylor College of Medicine, Texas Children's Hospital, Houston, TX (S.K.S.T., L.S.S.).
  • Shea JR; University of North Carolina at Chapel Hill (P.J., J.R.S.).
  • Shekerdemian LS; Baylor College of Medicine, Texas Children's Hospital, Houston, TX (S.K.S.T., L.S.S.).
  • Srivastava S; Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE (D.T., S.S.).
  • Votava-Smith JK; Division of Cardiology (J.K.V.-S.), Children's Hospital Los Angeles and Keck School of USC, CA.
  • White S; Division of Hospital Medicine (S.W.), Children's Hospital Los Angeles and Keck School of USC, CA.
  • Newburger JW; Department of Cardiology, Boston Children's Hospital, Department of Pediatrics; Harvard Medical School, MA (A.D., J.W.N.).
Circulation ; 145(5): 345-356, 2022 02.
Article in English | MEDLINE | ID: covidwho-1807751
ABSTRACT

BACKGROUND:

Understanding the clinical course and short-term outcomes of suspected myocarditis after the coronavirus disease 2019 (COVID-19) vaccination has important public health implications in the decision to vaccinate youth.

METHODS:

We retrospectively collected data on patients <21 years old presenting before July 4, 2021, with suspected myocarditis within 30 days of COVID-19 vaccination. Lake Louise criteria were used for cardiac MRI findings. Myocarditis cases were classified as confirmed or probable on the basis of the Centers for Disease Control and Prevention definitions.

RESULTS:

We report on 139 adolescents and young adults with 140 episodes of suspected myocarditis (49 confirmed, 91 probable) at 26 centers. Most patients were male (n=126, 90.6%) and White (n=92, 66.2%); 29 (20.9%) were Hispanic; and the median age was 15.8 years (range, 12.1-20.3; interquartile range [IQR], 14.5-17.0). Suspected myocarditis occurred in 136 patients (97.8%) after the mRNA vaccine, with 131 (94.2%) after the Pfizer-BioNTech vaccine; 128 (91.4%) occurred after the second dose. Symptoms started at a median of 2 days (range, 0-22; IQR, 1-3) after vaccination. The most common symptom was chest pain (99.3%). Patients were treated with nonsteroidal anti-inflammatory drugs (81.3%), intravenous immunoglobulin (21.6%), glucocorticoids (21.6%), colchicine (7.9%), or no anti-inflammatory therapies (8.6%). Twenty-six patients (18.7%) were in the intensive care unit, 2 were treated with inotropic/vasoactive support, and none required extracorporeal membrane oxygenation or died. Median hospital stay was 2 days (range, 0-10; IQR, 2-3). All patients had elevated troponin I (n=111, 8.12 ng/mL; IQR, 3.50-15.90) or T (n=28, 0.61 ng/mL; IQR, 0.25-1.30); 69.8% had abnormal ECGs and arrhythmias (7 with nonsustained ventricular tachycardia); and 18.7% had left ventricular ejection fraction <55% on echocardiogram. Of 97 patients who underwent cardiac MRI at a median 5 days (range, 0-88; IQR, 3-17) from symptom onset, 75 (77.3%) had abnormal

findings:

74 (76.3%) had late gadolinium enhancement, 54 (55.7%) had myocardial edema, and 49 (50.5%) met Lake Louise criteria. Among 26 patients with left ventricular ejection fraction <55% on echocardiogram, all with follow-up had normalized function (n=25).

CONCLUSIONS:

Most cases of suspected COVID-19 vaccine myocarditis occurring in persons <21 years have a mild clinical course with rapid resolution of symptoms. Abnormal findings on cardiac MRI were frequent. Future studies should evaluate risk factors, mechanisms, and long-term outcomes.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Vaccines / COVID-19 / Myocarditis Type of study: Case report / Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Vaccines Limits: Adolescent / Adult / Child / Female / Humans / Male / Young adult Language: English Journal: Circulation Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Vaccines / COVID-19 / Myocarditis Type of study: Case report / Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid / Vaccines Limits: Adolescent / Adult / Child / Female / Humans / Male / Young adult Language: English Journal: Circulation Year: 2022 Document Type: Article