Dongngan T Truong1, Audrey Dionne2, Juan Carlos Muniz3, Kimberly E McHugh4, Michael A Portman5, Linda M Lambert1, Deepika Thacker6, Matthew D Elias7, Jennifer S Li8, Olga H Toro-Salazar9, Brett R Anderson10, Andrew M Atz4, C Monique Bohun11, M Jay Campbell8, Maryanne Chrisant12, Laura D'Addese12, Kirsten B Dummer13, Daniel Forsha14, Lowell H Frank15, Olivia H Frosch16, Sarah K Gelehrter16, Therese M Giglia7, Camden Hebson17, Supriya S Jain18, Pace Johnston19, Anita Krishnan15, Kristin C Lombardi20, Brian W McCrindle21, Elizabeth C Mitchell22, Koichi Miyata23, Trent Mizzi21, Robert M Parker24, Jyoti K Patel25, Christina Ronai11, Arash A Sabati26, Jenna Schauer5, S Kristen Sexson Tejtel27, J Ryan Shea19, Lara S Shekerdemian27, Shubhika Srivastava6, Jodie K Votava-Smith28, Sarah White29, Jane W Newburger2. 1. Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., L.M.L.). 2. Department of Cardiology, Boston Children's Hospital, Department of Pediatrics; Harvard Medical School, MA (A.D., J.W.N.). 3. Nicklaus Children's Hospital, Miami, FL (J.C.M.). 4. Department of Pediatrics, Medical University of South Carolina, Charleston (K.E.M., A.M.A.). 5. Seattle Children's, Department of Pediatrics, University of Washington (M.A.P., J.S.). 6. Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE (D.T., S.S.). 7. Division of Cardiology, The Children's Hospital of Philadelphia, PA (M.D.E., T.M.G.). 8. Duke University School of Medicine, Durham, NC (J.S.L., M.J.C.). 9. Connecticut Children's Medical Center and University of Connecticut School of Medicine, Farmington (O.H.T.-S.). 10. Division of Pediatric Cardiology; NewYork-Presbyterian/Columbia University Irving Medical Center (B.R.A.). 11. Oregon Health & Science University, Division of Pediatric Cardiology, Department of Pediatrics, Portland (C.M.B., C.R.). 12. The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (M.C., L.D.'A.). 13. Division of Pediatric Cardiology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego (K.B.D.). 14. Division of Pediatric Cardiology, Children's Mercy, Kansas City, MO (D.F.). 15. Division of Cardiology, Children's National Hospital, Washington, DC (L.H.F., A.K.). 16. Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (O.H.F., S.K.G.). 17. Children's of Alabama Department of Pediatrics, Division of Pediatric Cardiology, University of Alabama at Birmingham School of Medicine (C.H.). 18. Maria Fareri Children's Hospital at Westchester Medical Center/New York Medical College, Valhalla (S.S.J.). 19. University of North Carolina at Chapel Hill (P.J., J.R.S.). 20. Warren Alpert Medical School of Brown University; Division of Pediatric Cardiology, Hasbro Children's Hospital, Providence, RI (K.C.L.). 21. Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (B.W.M., T.M.). 22. Cohen Children's Medical Center (Northwell Health), New Hyde Park, NY (E.C.M.). 23. Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego, La Jolla and Rady Children's Hospital San Diego (K.M.). 24. Division of Critical Care, Connecticut Children's, Hartford (R.M.P.). 25. Division of Pediatric Cardiology, Riley Children's Hospital, Indianapolis, IN (J.K.P.). 26. Division of Pediatric Cardiology, Phoenix Children's Hospital, AZ (A.A.S.). 27. Baylor College of Medicine, Texas Children's Hospital, Houston, TX (S.K.S.T., L.S.S.). 28. Division of Cardiology (J.K.V.-S.), Children's Hospital Los Angeles and Keck School of USC, CA. 29. Division of Hospital Medicine (S.W.), Children's Hospital Los Angeles and Keck School of USC, CA.
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.
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.
Entities:
Keywords:
COVID-19 vaccines; adolescent; myocarditis; young adult
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