• Lydia Chelala, Jean Jeudy, Rydhwana Hossain, Geoffrey Rosenthal, Nicholas Pietris, and Charles White.
• University of Chicago Medicine, Chicago, Illinois.
• AJR Am J Roentgenol. 2021 Oct 27.

AbstractBackground: A possible association has been reported between COVID-19 mRNA vaccination and myocarditis. Objective: To describe cardiac MRI findings in patients with myocarditis after COVID-19 mRNA vaccination. Methods: This retrospective study included patients who underwent cardiac MRI between May 14, 2021 and June 14, 2021 for suspected myocarditis within 2 weeks of COVID-19 mRNA vaccination, without known prior COVID-19. Information regarding clinical presentation, hospital course, and postdischarge events, were recorded. A cardiothoracic imaging fellow and cardiothoracic radiologist reviewed cardiac MRI examinations in consensus. Data were summarized descriptively. Results: Of 52 patients who underwent cardiac MRI during the study period, 5 underwent MRI for suspected myocarditis after recent COVID-19 mRNA vaccination without known prior COVID-19. These 5 patients were all males with age ranging from 16 to 19 years (mean, 17.2±1.0 years) who presented within 4 days of the second dose of COVID-19 mRNA vaccine. Troponin levels were elevated in all patients (mean peak troponin I, 6.8±4.1 ng/mL). Alternate possible causes of myocarditis were deemed clinically unlikely based on medical history, physical examination, myocarditis viral panel, and toxicology screen. Cardiac MRI findings were consistent with myocarditis in all 5 patients based on Lake Louise criteria, including early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) in all patients and corresponding myocardial edema in 4 patients. All 5 patients had a favorable hospital course and were discharged in stable condition with improved or resolved symptoms after mean hospitalization length of 4.8 days. Two patients underwent repeat cardiac MRI that showed persistent, though decreased, LGE. Three patients reported mild intermittent self-resolving chest pain after discharge; 2 patients had no recurrent symptoms after discharge. Conclusion: In this small case series, all patients with myocarditis after COVID-19 vaccination were adolescent males and had a favorable initial clinical course. All patients showed cardiac MRI findings typical of myocarditis of other causes. LGE persisted in 2 patients undergoing repeat MRI. The observations do not establish causality. Clinical impact: Radiologists should be aware of the possible association of COVID-19 mRNA vaccination and myocarditis, and recognize the role of cardiac MRI in assessment of suspected myocarditis after COVID-19 vaccination.

2 keywords...

hide…