NYMC Faculty Publications

Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination

Dongngan T. Truong, Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., L.M.L.).
Audrey Dionne, Department of Cardiology, Boston Children's Hospital, Department of Pediatrics; Harvard Medical School, MA (A.D., J.W.N.).
Juan Carlos Muniz, Nicklaus Children's Hospital, Miami, FL (J.C.M.).
Kimberly E. McHugh, Department of Pediatrics, Medical University of South Carolina, Charleston (K.E.M., A.M.A.).
Michael A. Portman, Seattle Children's, Department of Pediatrics, University of Washington (M.A.P., J.S.).
Linda M. Lambert, Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., L.M.L.).
Deepika Thacker, Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE (D.T., S.S.).
Matthew D. Elias, Division of Cardiology, The Children's Hospital of Philadelphia, PA (M.D.E., T.M.G.).
Jennifer S. Li, Duke University School of Medicine, Durham, NC (J.S.L., M.J.C.).
Olga H. Toro-Salazar, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Farmington (O.H.T.-S.).
Brett R. Anderson, Division of Pediatric Cardiology; NewYork-Presbyterian/Columbia University Irving Medical Center (B.R.A.).
Andrew M. Atz, Department of Pediatrics, Medical University of South Carolina, Charleston (K.E.M., A.M.A.).
C Monique Bohun, Oregon Health & Science University, Division of Pediatric Cardiology, Department of Pediatrics, Portland (C.M.B., C.R.).
M Jay Campbell, Duke University School of Medicine, Durham, NC (J.S.L., M.J.C.).
Maryanne Chrisant, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (M.C., L.D.'A.).
Laura D'Addese, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (M.C., L.D.'A.).
Kirsten B. Dummer, Division of Pediatric Cardiology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego (K.B.D.).
Daniel Forsha, Division of Pediatric Cardiology, Children's Mercy, Kansas City, MO (D.F.).
Lowell H. Frank, Division of Cardiology, Children's National Hospital, Washington, DC (L.H.F., A.K.).
Olivia H. Frosch, Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (O.H.F., S.K.G.).
Sarah K. Gelehrter, Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (O.H.F., S.K.G.).
Therese M. Giglia, Division of Cardiology, The Children's Hospital of Philadelphia, PA (M.D.E., T.M.G.).
Camden Hebson, Children's of Alabama Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham School of Medicine (C.H.).
Supriya S. Jain, Maria Fareri Children's Hospital at Westchester Medical Center/New York Medical College, Valhalla (S.S.J.).Follow
Pace Johnston, University of North Carolina at Chapel Hill (P.J., J.R.S.).
Anita Krishnan, Division of Cardiology, Children's National Hospital, Washington, DC (L.H.F., A.K.).
Kristin C. Lombardi, Warren Alpert Medical School of Brown University; Division of Pediatric Cardiology, Hasbro Children's Hospital, Providence, RI (K.C.L.).
Brian W. McCrindle, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (B.W.M., T.M.).
Elizabeth C. Mitchell, Cohen Children's Medical Center (Northwell Health), New Hyde Park, NY (E.C.M.).
Koichi Miyata, Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego, La Jolla and Rady Children's Hospital San Diego (K.M.).
Trent Mizzi, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (B.W.M., T.M.).
Robert M. Parker

Author Type(s)

Faculty

DOI

10.1161/CIRCULATIONAHA.121.056583

Journal Title

Circulation

First Page

345

Last Page

356

Document Type

Article

Publication Date

2-1-2022

Department

Pediatrics

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.

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