Infectious Disease
Myocarditis Treatable After COVID-19 Vaccine; AHA calls for continued vaccination
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Rosner does not report any relevant financial information. Please refer to the study for the relevant financial information from the other authors.
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Seven patients who developed myocarditis-like symptoms after the COVID-19 vaccination were able to recover after treatment, according to a case series published in Circulation.
As Healio previously reported, the CDC is investigating “relatively few” reports of myocarditis in young recipients of messenger RNA-based COVID-19 vaccines. As of June 10, 226 cases had been reported, compared to an expected 100 cases. A meeting of the CDC Advisory Committee on Vaccination Practices to discuss the issue was scheduled for June 18, but has been scheduled for June 23-25. June postponed.
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Symptoms after vaccination
In the Circulation publication, researchers documented seven male patients aged 19 to 39 who had symptoms similar to myocarditis after receiving a COVID-19 vaccine; five received the mRNA vaccine from Pfizer / BioNTech, one received the mRNA vaccine from Moderna, and one received the non-mRNA vaccine from Johnson & Johnson. Treatments varied and included beta-blockers and anti-inflammatory agents, and symptoms were resolved on discharge from hospital in all patients. The average length of stay in the hospital was 3 days.
In a related press release, the American Heart Association said the myocarditis reports shouldn’t discourage people from getting vaccinated against COVID-19.
“The American Heart Association continues to urge all adults and children 12 years and older in the US to get a COVID-19 vaccine as recommended by the CDC. Research continues to show that the COVID-19 vaccines are 91% effective in preventing severe COVID-19 infection and spreading the virus to others. In addition, the benefits of vaccination far outweigh the very unusual risks, ”the AHA said in a statement. “According to the CDC, fewer than 1,000 cases of myocarditis-like illness were reported as of May 31, 2021, and nearly 312 million doses of COVID-19 vaccines have been administered in the US to date.”
Imaging, biomarker findings
In the circular sheet, Carolyn M. Rosner, MSN, NP-C, MBA, Nurse Practitioner at Inova Health System, and colleagues wrote that all patients had acute chest pain and signs of myocardial damage based on either cardiac troponin I or highly sensitive troponin I 3 to 7 days after vaccination. Three patients had invasive coronary angiography, but none had evidence of obstructive CAD.
All patients had multifocal subepicardial late gadolinium accumulation on cardiac MRI and four had mid-myocardial late gadolinium accumulation, while three had evidence of myocardial edema, the researchers said.
None of the patients had active viral or autoimmune disease, and the six patients who tested for COVID-19 were negative, wrote Rosner and colleagues.
Four of the six patients tested for COVID-19 had evidence of spike protein IgG antibodies, according to the researchers.
“Our series of seven male COVID-19 vaccine recipients who presented with a myocarditis-like disease supports a possible causal relationship with the vaccination given the timing, clinical presentation and CMR findings,” wrote Rosner and colleagues. “Although the endomyocardial biopsy was negative in the only case it was performed, given the patchy nature of myocardial inflammation in myocarditis, this may indicate a sampling error. Of the two patients without measurable spike protein IgG, both presented shortly after their first vaccination dose. This antibody response is not unexpected, but it may indicate a different vaccine-related immune mechanism or the lack of causality with the vaccine. Additional studies are needed to confirm whether the rate of myocarditis-like disease after vaccination is higher than the background rate of myocarditis in the population of the same age.
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