J Korean Med Sci.  2024 Jan;39(4):e42. 10.3346/jkms.2024.39.e42.

Cardiac Magnetic Resonance Imaging Findings and Clinical Features of COVID-19 Vaccine-Associated Myocarditis, Compared With Those of Other Types of Myocarditis

• Kim SG
• Lee JY
• Jeong WG
• Lee JE
• Kim YH

• KMID: 2551971
• DOI: http://doi.org/10.3346/jkms.2024.39.e42

Abstract

Background
To compare the clinical and cardiac magnetic resonance (CMR) imaging findings of coronavirus disease 2019 (COVID-19) vaccine-associated myocarditis (VAM) with those of other types of myocarditis.
Methods
From January 2020 to March 2022, a total of 39 patients diagnosed with myocarditis via CMR according to the Modified Lake Louise criteria were included in the present study. The patients were classified into two groups based on their vaccination status: COVID-19 VAM and other types of myocarditis not associated with COVID-19 vaccination. Clinical outcomes, including the development of clinically significant arrhythmias, sudden cardiac arrest, and death, and CMR imaging features were compared between COVID-19 VAM and other types of myocarditis.
Results
Of the 39 included patients (mean age, 39 years ± 16.4 [standard deviation]; 23 men), 23 (59%) had COVID-19 VAM and 16 (41%) had other types of myocarditis. The occurrence of clinical adverse events did not differ significantly between the two groups. As per the CMR imaging findings, the presence and dominant pattern of late gadolinium enhancement did not differ significantly between the two groups. The presence of high native T1 or T2 values was not significantly different between the two groups. Although the native T1 and T2 values tended to be lower in COVID-19 VAM than in other types of myocarditis, there were no statistically significant differences between the native T1 and T2 values in the two groups.
Conclusion
The present study demonstrated that the CMR imaging findings and clinical outcomes of COVID-19 VAM did not differ significantly from those of other types of myocarditis during hospitalization.

Keyword

COVID-19 Vaccine-Associated Myocarditis; Other Myocarditis; Late Gadolinium Enhancement; Clinical Adverse Event

Figure

• 

  Fig. 1 Flow chart detailing the patient selection procedure.MRI = magnetic resonance imaging, COVID-19 = coronavirus disease 2019.

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  Fig. 2 COVID-19 vaccine-associated myocarditis in an 18-year-old man who presented with chest pain 3 days after COVID-19 vaccination (Pfizer-BioNTech). Cardiac magnetic resonance imaging performed 6 days after symptom onset shows mid-wall to subepicardial late gadolinium enhancement in the basal to the mid lateral wall of the left ventricle (A, arrows), corresponding hyperintense lesion in T2-weighted imaging (B, arrows), high regional native T1 value (C, 1,317 msec, maximum region of interest, arrows), and high regional native T2 value (D, 50 msec, maximum region of interest, arrows) in the short-axis images, suggesting acute myopericarditis (institutional reference values: native T1 at 1,185.4 ± 25.5 ms, native T2 at 35.6 ± 5.4 ms, respectively).COVID-19 = coronavirus disease 2019.

• 

  Fig. 3 Acute myocarditis without coronavirus disease 2019 vaccination history in a 26-year-old man who presented with anterior chest pain 2 days ago. The cardiac magnetic resonance imaging shows subepicardial late gadolinium enhancement in the mid inferior wall of the left ventricle (A, arrows), corresponding hyperintense lesion in the T2-weighted imaging (B, arrows), high regional native T1 value (C, 1,291 msec, maximum region of interest, arrows), and high regional native T2 value (D, 47 msec, maximum region of interest, arrows) in the short-axis images, suggesting acute myocarditis (institutional reference values: native T1 at 1,185.4 ± 25.5 ms, native T2 at 35.6 ± 5.4 ms, respectively).

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  Fig. 4 Boxplot: total LGE scores of coronavirus disease 2019 vaccine-associated myocarditis and other types of myocarditis.LGE = late gadolinium enhancement.

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  Fig. 5 Boxplot: average of the native T1 values of coronavirus disease 2019 vaccine-associated myocarditis and other types of myocarditis (institutional reference values: native T1 at 1,185.4 ± 25.5 ms, native T2 at 35.6 ± 5.4 ms, respectively).

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  Fig. 6 Boxplot: average of the native T2 values of coronavirus disease 2019 vaccine-associated myocarditis and other types of myocarditis (institutional reference values: native T1 at 1,185.4 ± 25.5 ms, native T2 at 35.6 ± 5.4 ms, respectively).

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