Introduction
Mass immunization campaigns have been initiated to contain the ongoing COVID-19 pandemic. COVID-19 vaccines currently authorized for emergency use in the United States include BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna) and JNJ-78436735 (Johnson and Johnson). Recently the lay press has reported concerns for vaccine associated myocarditis(1). In this work we describe cardiac MRI findings in patients with myocarditis detected shortly after COVID-19 mRNA vaccination.
Materials and Methods
In this retrospective, IRB approved HIPPA compliant study, cardiac MRI exams performed at our institution between 1/1/2021-5/25/2021 were reviewed for MRI findings of myocarditis/pericarditis. Subsequently, electronic health records were reviewed, and all patients who received COVID-19 vaccine preceding cardiac MRI were included (consecutive sample). Informed consent was waived per IRB protocol. Patients with a history of prior COVID were excluded.
Cardiac MRI was performed at 1.5T/3T (GE Healthcare) and evaluated as recently described(2). Clinical radiology reports were reviewed by three cardiovascular radiologists (7-27 years of experience; initials blinded for review) in consensus. Demographic and clinical data including COVID-19 vaccination, 12-lead electrocardiogram (ECG), and serum markers of cardiac injury were documented.
Results
Five patients (4:1 male:female, age range 17-38 years) were identified who had abnormal MRI findings and were vaccinated against COVID-19 prior to MRI. Cardiac troponin and ECG were abnormal in all patients. All patients were hospitalized due to acute onset of chest pain with diagnosis of acute myocarditis.
Patients 1-3 received their second dose of BNT162b2 vaccine two, three and two days, respectively, before onset of chest pain; Patients 4 and 5 both received their second dose of mRNA-1273 three days before onset of chest pain. In all patients, MRI showed myocarditis-like findings including non-ischemic pattern of late gadolinium enhancement, corresponding signal abnormalities on T2-weighted images, and pericardial enhancement (Table/Figure). Diagnostic considerations included pulmonary embolus or acute coronary event with additional imaging-based testing (Table). Ipsilateral axillary lymphadenopathy to the vaccination site was identified in four patients. COVID-19 testing at the time of diagnosis (and history of prior COVID-19) were negative. No respiratory symptoms, prodrome or skin rash were present prior to vaccination. Further, medical history did not reveal any pre-existing cardiac disease in these patients.
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