Heidecker, Bettina, Dagan, Noa, Balicer, Ran, Eriksson, Urs, Rosano, Giuseppe, Coats, Andrew, Tschöpe, Carsten, Kelle, Sebastian, Poland, Gregory A., Frustaci, Andrea, Klingel, Karin, Martin, Pilar, Hare, Joshua M., Cooper, Leslie T., Pantazis, Antonis, Imazio, Massimo, Prasad, Sanjay and Lüscher, Thomas F. (2022) Myocarditis following COVID ‐19 vaccine : incidence, presentation, diagnosis, pathophysiology, therapy, and outcomes put into perspective. A clinical consensus document supported by the Heart Failure Association of the European Society of Cardiology (ESC) and the ESC Working Group on Myocardial and Pericardial Diseases. European Journal of Heart Failure . doi:10.1002/ejhf.2669 ISSN 1388-9842. (In Press)

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Abstract

Over 10 million doses of COVID-19 vaccines based on RNA technology, viral vectors, recombinant protein, and inactivated virus have been administered worldwide. Although generally very safe, post-vaccine myocarditis can result from adaptive humoral and cellular, cardiac-specific inflammation within days and weeks of vaccination. Rates of vaccine-associated myocarditis vary by age and sex with the highest rates in males between 12 and 39 years. The clinical course is generally mild with rare cases of left ventricular dysfunction, heart failure and arrhythmias. Mild cases are likely underdiagnosed as cardiac magnetic resonance imaging (CMR) is not commonly performed even in suspected cases and not at all in asymptomatic and mildly symptomatic patients. Hospitalization of symptomatic patients with electrocardiographic changes and increased plasma troponin levels is considered necessary in the acute phase to monitor for arrhythmias and potential decline in left ventricular function. In addition to evaluation for symptoms, electrocardiographic changes and elevated troponin levels, CMR is the best non-invasive diagnostic tool with endomyocardial biopsy being restricted to severe cases with heart failure and/or arrhythmias. The management beyond guideline-directed treatment of heart failure and arrhythmias includes non-specific measures to control pain. Anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs, and corticosteroids have been used in more severe cases, with only anecdotal evidence for their effectiveness. In all age groups studied, the overall risks of SARS-CoV-2 infection-related hospitalization and death are hugely greater than the risks from post-vaccine myocarditis. This consensus statement serves as a practical resource for physicians in their clinical practice, to understand, diagnose, and manage affected patients. Furthermore, it is intended to stimulate research in this area.

Item Type:	Journal Article
Subjects:	Q Science > QR Microbiology R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	COVID-19 (Disease) , COVID-19 vaccines, Myocarditis, Heart failure
Journal or Publication Title:	European Journal of Heart Failure
Publisher:	John Wiley & Sons Ltd.
ISSN:	1388-9842
Official Date:	2022
Dates:	Date Event 2022 Published 6 October 2022 Available 25 August 2022 Accepted 4 June 2022 Submitted
DOI:	10.1002/ejhf.2669
Status:	Peer Reviewed
Publication Status:	In Press
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	11 October 2022
Date of first compliant Open Access:	11 October 2022

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