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Reassurance Data regarding Rare Myocarditis after COVID-19 Immunization

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Adolescents and adults younger than age 21 who develop myocarditis after the COVID-19 mRNA vaccination often have abnormal findings on cardiac MRI (cMRI) however, the majority suffer from a mild course with rapid resolution of symptoms, a new study concludes.

“This study supports the findings we’ve been seeing. Patients who were treated and diagnosed promptly for the rare complication of COVID-19 related to myocarditis experienced only mild cases and a brief recovery time,” American Heart Association President Donald M. Lloyd Jones, MD, stated in an interview.

Lloyd-Jones said that “overwhelmingly evidence continues to show that the benefits of COVID-19 vaccination outweigh any extremely rare adverse events from vaccine such as myocarditis.”

The study was published online today by the journal Circulation..

Using data from 26 pediatric medical centers across the United States and Canada, the researchers reviewed the medical records of 139 patients younger than 21 who were suspected to have myocarditis within a month of receiving a COVID-19 vaccination.

They made the following observations:

  • The majority of patients were male (90.6 percent), White (66.2%) and had an average age of 15.8 years.

  • Suspected myocarditis was reported in the 136 patients (97.8 percent) in 131 (94.2%) after the Pfizer BioNTech vaccine, and 128 (91.4%) cases following the second dose.

  • After vaccination, symptoms began in the median of 2 days (range: 0 to 22).

  • The most frequent sign was chest pain (99.3%) followed by fever in 30.9% and shortness-of-breath in 27.3 percent.

  • Patients were treated with nonsteroidal anti-inflammatory drugs (81.3%) and intravenous immuneglobulin (21.6%). The glucocorticoids (21.6 percent). colchicine (7.9%). Or, no anti-inflammatory treatment (8.6%).

  • Twenty-six patients (18.7%), were admitted to the ICU. 2 received inotropic/vasoactive treatment; none required extracorporeal oxygenation.

  • Median time spent in hospital was 2 days.

  • A total of 111 patients had troponin levels above 8.00 ng/mL, while 28 had troponin levels below 0.61 ng/mL.

  • More than two thirds (69.8%) had abnormal electrocardiograms and/or arrhythmias (7 with nonsustained ventricular Tachycardia).

  • Twenty-six patients (or 18.7 percent) had left their ventricular Ejection Fractions (LVEF) 55% in echocardiogram. The LVEF was normalized in the 25 patients who returned for follow-up.

  • 75 of 97 patients (77.3%) who underwent cMRI 5 days after the onset of symptoms had abnormal findings; 74 (76.3%) showed gadolinium enhancement late, 54 (55.7%) had myocardial edema, and 49 (50.5 percent) met Lake Louise criteria for myocarditis.

“These results suggest that the majority of cases of suspected COVID-19 vaccine-related myocarditis among people younger than 21 are mild and resolve quickly,” corresponding author Dongngan Truong, MD, Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, said in an announcement.

“We were very happy to see that type of recovery. We are still awaiting more studies to better understand the long-term outcomes of patients who have suffered COVID-19 vaccination-related myocarditis. Truong said that we should to also study the risk factors and mechanisms of this rare complications.”

Lloyd-Jones stated that these findings support AHA’s belief that COVID-19 vaccinations are safe and highly effective. They are essential to saving lives and protecting our families and communities from COVID-19 and putting an end to the epidemic.

The study was not funded. Truong consults with Pfizer regarding the myocarditis that is a result of vaccination. A complete list of author disclosures is provided in the original report.

Circulation. Published online December 6, 20, 21. Abstract

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