tetano
Editor, Senior Moderator
Am Heart J
. 2023 Nov 11:S0002-8703(23)00315-0.
doi: 10.1016/j.ahj.2023.11.006. Online ahead of print. Clinical course and follow-up of pediatric patients with COVID-19 vaccine-associated myocarditis compared to non-vaccine-associated myocarditis within the prospective multi-center registry - "MYKKE": Short Title: Pediatric COVID-19 vaccine-associated myocarditis
Nele Rolfs[SUP] 1 [/SUP], Cynthia Huber[SUP] 2 [/SUP], Eicke Schwarzkopf[SUP] 3 [/SUP], Dirk Mentzer[SUP] 4 [/SUP], B Keller-Stanislawski[SUP] 4 [/SUP], Bernd Opgen-Rhein[SUP] 3 [/SUP], Wiebke Frede[SUP] 5 [/SUP], Axel Rentzsch[SUP] 6 [/SUP], Tobias Hecht[SUP] 7 [/SUP], Martin Boehne[SUP] 8 [/SUP], Maria Grafmann[SUP] 9 [/SUP], Daniela Kiski[SUP] 10 [/SUP], Iva Graumann[SUP] 11 [/SUP], Rudi Foth[SUP] 12 [/SUP], Inga Voges[SUP] 13 [/SUP], Ulrich Schweigmann[SUP] 14 [/SUP], Bettina Ruf[SUP] 15 [/SUP], Marcus Fischer[SUP] 16 [/SUP], Gesa Wiegand[SUP] 17 [/SUP], Karin Klingel[SUP] 18 [/SUP], Thomas Pickardt[SUP] 19 [/SUP], Tim Friede[SUP] 2 [/SUP], Daniel Messroghli[SUP] 20 [/SUP], Stephan Schubert[SUP] 21 [/SUP], Franziska Seidel[SUP] 22 [/SUP]; MYKKE consortium
Affiliations
Background: Since the onset of widespread COVID-19 vaccination, increased incidence of COVID-19 vaccine-associated myocarditis (VA-myocarditis) has been noted, particularly in male adolescents.
Methods: Patients <18 years with suspected myocarditis following COVID-19 vaccination within 21 days were enrolled in the PedMYCVAC cohort, a substudy within the prospective multi-center registry for pediatric myocarditis "MYKKE". Clinical data at initial admission, 3- and 9-months follow-up were monitored and compared to pediatric patients with confirmed non-vaccine-associated myocarditis (NVA-myocarditis) adjusting for various baseline characteristics.
Results: From July 2021 to December 2022, 56 patients with VA-myocarditis across 15 centers were enrolled (median age 16.3 years, 91% male). Initially, 11 patients (20%) had mildly reduced left ventricular ejection fraction (LVEF; 45-54%). No incidents of severe heart failure, transplantation or death were observed. Of 49 patients at 3-months follow-up (median (IQR) 94 (63-118) days), residual symptoms were registered in 14 patients (29%), most commonly atypical intermittent chest pain and fatigue. Diagnostic abnormalities remained in 23 patients (47%). Of 21 patients at 9-months follow-up (259 (218-319) days), all were free of symptoms and diagnostic abnormalities remained in 9 patients (43%). These residuals were mostly residual late gadolinium enhancement in magnetic resonance imaging. Patients with NVA-myocarditis (n=108) more often had symptoms of heart failure (p=0.003), arrhythmias (p=0.031), left ventricular dilatation (p=0.045), lower LVEF (p<0.001) and major cardiac adverse events (p=0.102).
Conclusion: Course of COVID-19 vaccine-associated myocarditis in pediatric patients seems to be mild and differs from non-vaccine-associated myocarditis. Due to a considerable number of residual symptoms and diagnostic abnormalities at follow-up, further studies are needed to define its long-term implications.
Keywords: BMI, Body-Mass-Index; BSA, Body surface area; CMRI, Cardiac magnetic resonance imaging; COVID-19 vaccine; COVID-19, Coronavirus disease 2019; CRP, C-reactive protein; ECG, Electrocardiogram; EMB, Endomyocardial biopsy; GLM, Generalized linear model; HTX, Heart transplantation; Hs-cTnT, High-sensitivity troponin T; IL-1RA, Interleukin-1 receptor antagonist; IQR, Interquartile range; LGE, Late gadolinium enhancement; LVEDD, Left ventricular end-diastolic diameter; LVEDV, Left ventricular end-diastolic volume; LVEF, Left ventricular ejection fraction; LVNC, Left ventricular non-compaction cardiomyopathy; MACE, Major adverse cardiovascular events; MCS, Mechanical circulatory support; MRNA, Messenger ribonucleic acid; Myocarditis; NSAIDs, Nonsteroidal anti-inflammatory drugs; NSVT, Non-sustained ventricular tachycardia; NT-proBNP, N-terminal prohormone of brain natriuretic peptide (BNP); NVA-myocarditis, Non-vaccine-associated myocarditis; NYHA, New York Heart Association; VA-myocarditis, Vaccine-associated myocarditis; comparison ABBREVIATIONS: ARVC, Arrhythmogenic right ventricular cardiomyopathy; follow-up; pediatric.
. 2023 Nov 11:S0002-8703(23)00315-0.
doi: 10.1016/j.ahj.2023.11.006. Online ahead of print. Clinical course and follow-up of pediatric patients with COVID-19 vaccine-associated myocarditis compared to non-vaccine-associated myocarditis within the prospective multi-center registry - "MYKKE": Short Title: Pediatric COVID-19 vaccine-associated myocarditis
Nele Rolfs[SUP] 1 [/SUP], Cynthia Huber[SUP] 2 [/SUP], Eicke Schwarzkopf[SUP] 3 [/SUP], Dirk Mentzer[SUP] 4 [/SUP], B Keller-Stanislawski[SUP] 4 [/SUP], Bernd Opgen-Rhein[SUP] 3 [/SUP], Wiebke Frede[SUP] 5 [/SUP], Axel Rentzsch[SUP] 6 [/SUP], Tobias Hecht[SUP] 7 [/SUP], Martin Boehne[SUP] 8 [/SUP], Maria Grafmann[SUP] 9 [/SUP], Daniela Kiski[SUP] 10 [/SUP], Iva Graumann[SUP] 11 [/SUP], Rudi Foth[SUP] 12 [/SUP], Inga Voges[SUP] 13 [/SUP], Ulrich Schweigmann[SUP] 14 [/SUP], Bettina Ruf[SUP] 15 [/SUP], Marcus Fischer[SUP] 16 [/SUP], Gesa Wiegand[SUP] 17 [/SUP], Karin Klingel[SUP] 18 [/SUP], Thomas Pickardt[SUP] 19 [/SUP], Tim Friede[SUP] 2 [/SUP], Daniel Messroghli[SUP] 20 [/SUP], Stephan Schubert[SUP] 21 [/SUP], Franziska Seidel[SUP] 22 [/SUP]; MYKKE consortium
Affiliations
- PMID: 37956921
- DOI: 10.1016/j.ahj.2023.11.006
Background: Since the onset of widespread COVID-19 vaccination, increased incidence of COVID-19 vaccine-associated myocarditis (VA-myocarditis) has been noted, particularly in male adolescents.
Methods: Patients <18 years with suspected myocarditis following COVID-19 vaccination within 21 days were enrolled in the PedMYCVAC cohort, a substudy within the prospective multi-center registry for pediatric myocarditis "MYKKE". Clinical data at initial admission, 3- and 9-months follow-up were monitored and compared to pediatric patients with confirmed non-vaccine-associated myocarditis (NVA-myocarditis) adjusting for various baseline characteristics.
Results: From July 2021 to December 2022, 56 patients with VA-myocarditis across 15 centers were enrolled (median age 16.3 years, 91% male). Initially, 11 patients (20%) had mildly reduced left ventricular ejection fraction (LVEF; 45-54%). No incidents of severe heart failure, transplantation or death were observed. Of 49 patients at 3-months follow-up (median (IQR) 94 (63-118) days), residual symptoms were registered in 14 patients (29%), most commonly atypical intermittent chest pain and fatigue. Diagnostic abnormalities remained in 23 patients (47%). Of 21 patients at 9-months follow-up (259 (218-319) days), all were free of symptoms and diagnostic abnormalities remained in 9 patients (43%). These residuals were mostly residual late gadolinium enhancement in magnetic resonance imaging. Patients with NVA-myocarditis (n=108) more often had symptoms of heart failure (p=0.003), arrhythmias (p=0.031), left ventricular dilatation (p=0.045), lower LVEF (p<0.001) and major cardiac adverse events (p=0.102).
Conclusion: Course of COVID-19 vaccine-associated myocarditis in pediatric patients seems to be mild and differs from non-vaccine-associated myocarditis. Due to a considerable number of residual symptoms and diagnostic abnormalities at follow-up, further studies are needed to define its long-term implications.
Keywords: BMI, Body-Mass-Index; BSA, Body surface area; CMRI, Cardiac magnetic resonance imaging; COVID-19 vaccine; COVID-19, Coronavirus disease 2019; CRP, C-reactive protein; ECG, Electrocardiogram; EMB, Endomyocardial biopsy; GLM, Generalized linear model; HTX, Heart transplantation; Hs-cTnT, High-sensitivity troponin T; IL-1RA, Interleukin-1 receptor antagonist; IQR, Interquartile range; LGE, Late gadolinium enhancement; LVEDD, Left ventricular end-diastolic diameter; LVEDV, Left ventricular end-diastolic volume; LVEF, Left ventricular ejection fraction; LVNC, Left ventricular non-compaction cardiomyopathy; MACE, Major adverse cardiovascular events; MCS, Mechanical circulatory support; MRNA, Messenger ribonucleic acid; Myocarditis; NSAIDs, Nonsteroidal anti-inflammatory drugs; NSVT, Non-sustained ventricular tachycardia; NT-proBNP, N-terminal prohormone of brain natriuretic peptide (BNP); NVA-myocarditis, Non-vaccine-associated myocarditis; NYHA, New York Heart Association; VA-myocarditis, Vaccine-associated myocarditis; comparison ABBREVIATIONS: ARVC, Arrhythmogenic right ventricular cardiomyopathy; follow-up; pediatric.