Cardiac MRI Findings of Myocarditis After COVID-19 mRNA Vaccination in Adolescents
Cardiac MRI Findings of Myocarditis After COVID-19 mRNA Vaccination in Adolescents
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DOI：
10.2214/ajr.21.26853
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发表时间：
2022-04-01
影响因子：
5
通讯作者：
White, Charles S.
中科院分区：
文献类型：
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作者：
Chelala, Lydia;Jeudy, Jean;White, Charles S.
背景据报道，COVID-19信使RNA（mRNA）疫苗接种与心肌炎之间可能存在关联。本研究旨在描述COVID-19 mRNA疫苗接种后心肌炎患者的心脏MRI表现。这项回顾性研究纳入了在2021年5月14日至2021年6月14日期间因COVID-19 mRNA疫苗接种后2周内疑似心肌炎而接受心脏MRI检查的既往无已知SARSCoV-2感染的患者。记录有关临床表现、住院过程和出院后事件的信息。心胸影像学研究员和心胸放射科医师一致审查了心脏MRI检查。对数据进行描述性总结。结果。在研究期间接受心脏MRI检查的52名既往无已知SARS-CoV-2感染的患者中，有5名在最近接种COVID-19 mRNA疫苗后因疑似心肌炎接受了MRI检查。所有5名患者均为男性患者，年龄范围为16至19岁（平均17.2 +/- 1.0 [SD]岁），在接受第二剂COVID-19 mRNA疫苗后4天内就诊。所有患者的肌钙蛋白水平均升高（平均肌钙蛋白I峰值，6.82 ± 4.13 ng/mL）。根据病史、体格检查结果、心肌炎病毒检测和毒理学筛查，认为心肌炎的其他可能原因在临床上不太可能。根据露易丝湖标准，所有5例患者的心脏MRI结果均与心肌炎一致，包括所有患者的早期钆增强和晚期钆增强（LGE），4例患者的相应心肌水肿。所有5例患者的住院过程良好，出院时病情稳定，住院后症状改善或消退（平均住院时间为4.8天）。2例患者接受了重复心脏MRI，显示持续性LGE，尽管有所降低。3例患者出院后报告轻度间歇性自行缓解胸痛，2例患者出院后无复发症状。在这个小病例系列中，所有COVID-19疫苗接种后心肌炎的患者都是男性青少年，并且具有良好的初始临床病程。所有患者的心脏MRI表现均为其他原因引起的心肌炎的典型表现。两名接受重复MRI的患者持续存在LGE。这些观察结果不能确定因果关系。
BACKGROUND. A possible association has been reported between COVID-19 messenger RNA (mRNA) vaccination and myocarditis.OBJECTIVE. The purpose of our study was to describe cardiac MRI findings in patients with myocarditis after COVID-19 mRNA vaccination.METHODS. This retrospective study included patients without known prior SARSCoV-2 infection who underwent cardiac MRI between May 14, 2021, and June 14, 2021, for suspected myocarditis within 2 weeks of COVID-19 mRNA vaccination. Information regarding clinical presentation, hospital course, and events after hospital discharge were recorded. A cardiothoracic imaging fellow and cardiothoracic radiologist reviewed cardiac MRI examinations in consensus. Data were summarized descriptively.RESULTS. Of 52 patients without known prior SARS-CoV-2 infection who underwent cardiac MRI during the study period, five underwent MRI for suspected myocarditis after recent COVID-19 mRNA vaccination. All five patients were male patients ranging in age from 16 to 19 years (mean, 17.2 +/- 1.0 [SD] years) who presented within 4 days of receiving the second dose of a COVID-19 mRNA vaccine. Troponin levels were elevated in all patients (mean peak troponin I value, 6.82 +/- 4.13 ng/mL). Alternate possible causes of myocarditis were deemed clinically unlikely on the basis of medical history, physical examination findings, myocarditis viral panel, and toxicology screening. Cardiac MRI findings were consistent with myocarditis in all five patients on the basis of the Lake Louise criteria, including early gadolinium enhancement and late gadolinium enhancement (LGE) in all patients and corresponding myocardial edema in four patients. All five patients had a favorable hospital course and were discharged from the hospital in stable condition with improved or resolved symptoms after hospitalization (mean length of hospital stay, 4.8 days). Two patients underwent repeat cardiac MRI that showed persistent, although decreased, LGE. Three patients reported mild intermittent self-resolving chest pain after hospital discharge, and two patients had no recurrent symptoms after discharge.CONCLUSION. In this small case series, all patients with myocarditis after COVID-19 vaccination were male adolescents and had a favorable initial clinical course. All patients showed cardiac MRI findings typical of myocarditis from other causes. LGE persisted in two patients who underwent repeat MRI. These observations do not establish causality.