Immunological response and temporal associations in myocarditis after COVID-19 vaccination
using cardiac magnetic resonance imaging: an amplified T-cell response at the heart
of it?
(Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University)
(K135076)
(2020-1.1.6-JOVO-2021-00013)
Az orvos-, egészségtudományi- és gyógyszerészképzés tudományos műhelyeinek fejlesztése(EFOP-3.6.3-VEKOP-16-2017-00009)
Támogató: EFOP-VEKOP
Szakterületek:
Klinikai orvostan
IntroductionAlthough myocarditis after anti-SARS-CoV-2 vaccination is increasingly
recognized, we have little data regarding the course of the disease and, consequently,
the imaging findings, including the tissue-specific features. The purpose of this
study is to describe the clinical, immunological, and cardiac magnetic resonance (CMR)
features of myocarditis after COVID-19 immunization in the acute phase and during
follow-up. We aimed to compare the trajectory of the disease to myocarditis cases
unrelated to COVID-19.MethodsWe assembled a CMR-based registry of potentially
COVID-19 vaccination-related myocarditis cases. All patients who experienced new-onset
chest pain and troponin elevation after COVID-19 vaccination and imaging confirming
the clinical suspicion of acute myocarditis were enrolled in our study. Participants
underwent routine laboratory testing and testing of their humoral and cellular immune
response to COVID-19 vaccination. Clinical and CMR follow-up was performed after 3–6
months. We included two separate, sex- and age-matched control groups: (1) individuals
with myocarditis unrelated to COVID-19 infection or vaccination confirmed by CMR and
(2) volunteers with similar immunological exposure to SARS-CoV-2 compared to our group
of interest (no difference in the number of doses, types and the time since anti-SARS-CoV-2
vaccination and no difference in anti-nucleocapsid levels).ResultsWe report
16 CMR-confirmed cases of myocarditis presenting (mean ± SD) 4 ± 2 days after administration
of the anti-SARS-CoV-2 vaccine (male patients, 22 ± 7 years), frequently with predisposing
factors such as immune-mediated disease and previous myocarditis. We found that 75%
received mRNA vaccines, and 25% received vector vaccines. During follow-up, CMR metrics
depicting myocardial injury, including oedema and necrosis, decreased or completely
disappeared. There was no difference regarding the CMR metrics between myocarditis
after immunization and myocarditis unrelated to COVID-19. We found an increased T-cell
response among myocarditis patients compared to matched controls (p < 0.01), while
there was no difference in the humoral immune response.ConclusionIn our
cohort, myocarditis occurred after both mRNA and vector anti-SARS-CoV-2 vaccination,
frequently in individuals with predisposing factors. Upon follow-up, the myocardial
injury had healed. Notably, an amplified cellular immune response was found in acute
myocarditis cases occurring 4 days after COVID-19 vaccination.
