A Series of Patients With Myocarditis Following SARS-CoV-2 Vaccination With mRNA-1279 and BNT162b2

U.S, September 2021, Dickey et al, JACC: Cardiovascular Imaging

Summary

Six previously healthy men (17-37 years of age) with no infectious prodrome developed severe chest pain and elevated troponin I within 2 days-4 days of their second vaccination (Figure 1). Five patients had ST-segment elevation on presentation, with 4 demonstrating no coronary artery obstruction. All patients had negative nasopharyngeal SARS-CoV-2 PCR testing. CMR revealed patchy midmyocardial increased T2 signal with corresponding late gadolinium enhancement consistent with the acute inflammation of myocarditis (Figure 1). Five patients had abnormal left ventricular systolic function.

Figure 1. Clinical Characteristics and Cardiac Magnetic Resonance Imaging of Patients Following SARS-CoV-2 Vaccination
(Top) Clinical characteristics of patients with myocarditis following SARS-CoV-2 vaccination. (Bottom) Cardiac magnetic resonance of myocarditis following vaccination. In each panel, T2-weighted sequences are on the left and late gadolinium (LGE) sequences are on the right. (A) Patient 1: short-axis and 4-chamber views demonstrating areas of increased T2 signal and LGE in the midwall of the lateral segments (arrowheads) in a patient who received their second SARS-CoV-2 vaccination 5 days earlier. (B) Patient 2: short-axis and 4-chamber views demonstrating increased T2 signal and LGE in the midwall and subepicardial layer throughout the left ventricle (arrowheads) in a patient who received their second SARS-CoV-2 vaccination 7 days earlier. (C) Patient 3: short-axis views demonstrating increased T2 signal and LGE in the mid wall and subepicardial layer of the mid-posterolateral segment (arrowheads) in a patient who received their second SARS-CoV-2 vaccination 6 days earlier. (D) Patient 6: 4-chamber view demonstrating areas of increased T2 signal and LGE in the subepicardial apical and apical lateral segments (arrowheads).

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