Supriya S Jain1, Jeremy M Steele2, Brian Fonseca3, Sihong Huang4, Sanket Shah5, Shiraz A Maskatia6, Sujatha Buddhe7, Nilanjana Misra8, Preeti Ramachandran9, Lasya Gaur10, Parham Eshtehardi11, Shafkat Anwar12, Neeru Kaushik13, Frank Han14, Nita Ray Chaudhuri15, Lars Grosse-Wortmann16. 1. New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York sjain7@nymc.edu. 2. School of Medicine, Yale University, New Haven, Connecticut. 3. Colorado Children's Hospital, Aurora, Colorado. 4. College of Human Medicine, Michigan State University and Helen DeVos Children's Hospital, Spectrum Health, Grand Rapids, Michigan. 5. Children's Mercy Hospital, Kansas City, Missouri. 6. School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California. 7. Seattle Children's Hospital and University of Washington, Seattle, Washington. 8. Cohen Children's Medical Center of New York, Northwell Health, Queens, New York. 9. University of Kentucky, Lexington, Kentucky. 10. School of Medicine, John Hopkins University, Baltimore, Maryland. 11. Northside Heart and Vascular Institute, Northside Hospital, Atlanta, Georgia. 12. University of California, San Francisco, San Francisco, California. 13. University of California, San Francisco Benioff Children's Hospitals, Oakland, California. 14. College of Medicine, University of Illinois, Peoria, Illinois. 15. West Virginia University, Morgantown, West Virginia. 16. Oregon Health and Science University, Portland, Oregon.
Abstract
OBJECTIVES: In this study, we aimed to characterize the clinical presentation, short-term prognosis, and myocardial tissue changes as noted on cardiovascular magnetic resonance (CMR) or cardiac MRI in pediatric patients with coronavirus disease 2019 vaccination-associated myocarditis (C-VAM). METHODS: In this retrospective multicenter study across 16 US hospitals, patients <21 years of age with a diagnosis of C-VAM were included and compared with a cohort with multisystem inflammatory syndrome in children. Younger children with C-VAM were compared with older adolescents. RESULTS: Sixty-three patients with a mean age of 15.6 years were included; 92% were male. All had received a messenger RNA vaccine and, except for one, presented after the second dose. Four patients had significant dysrhythmia; 14% had mild left ventricular dysfunction on echocardiography, which resolved on discharge; 88% met the diagnostic CMR Lake Louise criteria for myocarditis. Myocardial injury as evidenced by late gadolinium enhancement on CMR was more prevalent in comparison with multisystem inflammatory syndrome in children. None of the patients required inotropic, mechanical, or circulatory support. There were no deaths. Follow-up data obtained in 86% of patients at a mean of 35 days revealed resolution of symptoms, arrhythmias, and ventricular dysfunction. CONCLUSIONS: Clinical characteristics and early outcomes are similar between the different pediatric age groups in C-VAM. The hospital course is mild, with quick clinical recovery and excellent short-term outcomes. Myocardial injury and edema are noted on CMR. Close follow-up and further studies are needed to understand the long-term implications and mechanism of these myocardial tissue changes.
OBJECTIVES: In this study, we aimed to characterize the clinical presentation, short-term prognosis, and myocardial tissue changes as noted on cardiovascular magnetic resonance (CMR) or cardiac MRI in pediatric patients with coronavirus disease 2019 vaccination-associated myocarditis (C-VAM). METHODS: In this retrospective multicenter study across 16 US hospitals, patients <21 years of age with a diagnosis of C-VAM were included and compared with a cohort with multisystem inflammatory syndrome in children. Younger children with C-VAM were compared with older adolescents. RESULTS: Sixty-three patients with a mean age of 15.6 years were included; 92% were male. All had received a messenger RNA vaccine and, except for one, presented after the second dose. Four patients had significant dysrhythmia; 14% had mild left ventricular dysfunction on echocardiography, which resolved on discharge; 88% met the diagnostic CMR Lake Louise criteria for myocarditis. Myocardial injury as evidenced by late gadolinium enhancement on CMR was more prevalent in comparison with multisystem inflammatory syndrome in children. None of the patients required inotropic, mechanical, or circulatory support. There were no deaths. Follow-up data obtained in 86% of patients at a mean of 35 days revealed resolution of symptoms, arrhythmias, and ventricular dysfunction. CONCLUSIONS: Clinical characteristics and early outcomes are similar between the different pediatric age groups in C-VAM. The hospital course is mild, with quick clinical recovery and excellent short-term outcomes. Myocardial injury and edema are noted on CMR. Close follow-up and further studies are needed to understand the long-term implications and mechanism of these myocardial tissue changes.
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