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Tri Saputra PB, Kurniawan RB, Trilistyoati D, Al Farabi MJ, Susilo H, Alsagaff MY, Oktaviono YH, Sutanto H, Gusnanto A, Dyah Kencono Wungu C. Myocarditis and coronavirus disease 2019 vaccination: A systematic review and meta-summary of cases. BIOMOLECULES & BIOMEDICINE 2023; 23:546-567. [PMID: 36803547 PMCID: PMC10351100 DOI: 10.17305/bb.2022.8779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases was male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated (p < 0.01; OR, 5.74; 95% CI, 2.42-13.64) with the risk of myocarditis following the administration of the first dose, indicating that its primary mechanism is immune-mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant noninvasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of <12%, and mortality of <2%. The majority was treated with nonsteroidal anti-inflammatory drugs, colchicine, and steroids. Surprisingly, deceased cases had characteristics of being female, older age, non-chest pain symptoms, first-dose vaccination, left ventricular ejection fraction of <30%, fulminant myocarditis, and eosinophil infiltrate histopathology.
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Affiliation(s)
- Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | | | - Makhyan Jibril Al Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga–Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Henry Sutanto
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | | | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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Chiang M, Shih L, Lu C, Fang S. The COVID-19 vaccine did not affect the basal immune response and menstruation in female athletes. Physiol Rep 2023; 11:e15556. [PMID: 36750121 PMCID: PMC9904960 DOI: 10.14814/phy2.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023] Open
Abstract
The COVID-19 pandemic restricted the regular training and competition program of athletes. Vaccines against COVID-19 are known to be beneficial for the disease; however, the unknown side effects of vaccines and postvaccination reactions have made some athletes hesitant to get vaccinated. We investigated the changes in inflammatory responses and menstrual cycles of female athletes before and after vaccination. Twenty female athletes were enrolled in this study. Blood was collected from each subject before the first COVID-19 vaccination and after the first and second vaccinations. Laboratory data, including white blood cell, neutrophil, lymphocyte, and platelet counts, and inflammatory markers, including NLR (neutrophil-to-lymphocyte ratio), PLR (platelet lymphocyte ratio), RPR (red cell distribution width to platelet ratio), SII (systemic immune-inflammation index), and NeuPla (neutrophil-platelet ratio), were analyzed statistically. The menstrual changes before and after vaccination and the side effects were collected by questionnaires. No significant changes in the laboratory data were found after the first and second shots when compared to those at prevaccination: white blood cell, neutrophil, lymphocyte, platelet, NLR, PLR, SII, RPR, and NeuPla (p > 0.05). In addition, there were no significant changes in the menstruation cycle or days of the menstrual period (p > 0.05). All side effects after vaccination were mild and subsided in 2 days. The blood cell counts, inflammatory markers, and menstruation of female athletes were not affected by COVID-19 vaccines.
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Affiliation(s)
- Ming‐Ru Chiang
- Department of PediatricsJen‐Ai HospitalTaichungTaiwan
- Department of Exercise Health ScienceNational Taiwan University of SportTaichungTaiwan
| | - Li‐Chun Shih
- Department of Obstetrics and Gynecology, Puli BranchTaichung Veterans General HospitalNantouTaiwan
| | - Chi‐Cheng Lu
- Institute of AthleticsNational Taiwan University of SportTaichungTaiwan
| | - Shih‐Hua Fang
- Institute of AthleticsNational Taiwan University of SportTaichungTaiwan
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Samimisedeh P, Jafari Afshar E, Shafiabadi Hassani N, Rastad H. Cardiac MRI Findings in COVID-19 Vaccine-Related Myocarditis: A Pooled Analysis of 468 Patients. J Magn Reson Imaging 2022; 56:971-982. [PMID: 35612967 PMCID: PMC9348186 DOI: 10.1002/jmri.28268] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/11/2022] Open
Abstract
Understanding the pattern and severity of myocarditis caused by the coronavirus disease 2019 (COVID-19) vaccine is imperative for improving the care of the patients, and cardiac evaluation by MRI plays a key role in this regard. Our systematic review and meta-analysis aimed to summarize cardiac MRI findings in COVID-19 vaccine-related myocarditis. We performed a comprehensive systematic review of literature in PubMed, Scopus, and Google Scholar databases using key terms covering COVID-19 vaccine, myocarditis, and cardiac MRI. Individual-level patient data (IPD) and aggregated-level data (AD) studies were pooled through a two-stage analysis method. For this purpose, all IPD were first gathered into a single data set and reduced to AD, and then this AD (from IPD studies) was pooled with existing AD (from the AD studies) using fixed/random effect models. I2 was used to assess the degree of heterogeneity, and the prespecified level of statistical significance (P value for heterogeneity) was <0.1. Based on meta-analysis of 102 studies (n = 468 patients), 79% (95% confidence interval [CI]: 54%-97%) of patients fulfilled Lake Louise criteria (LLC) for diagnosis of myocarditis. Cardiac MRI abnormalities included elevated T2 in 72% (95% CI: 50%-90%), myocardial late gadolinium enhancement (LGE) in 93% (95% CI: 83%-99%; nearly all with a subepicardial and/or midwall pattern), impaired left ventricular ejection fraction (LVEF) (<50%) in 4% (95% CI: 1.0%-9.0%). Moreover, elevated T1 and extracellular volume fraction (ECV) (>30), reported only by some IPD studies, were detected in 74.5% (76/102) and 32% (16/50) of patients, respectively. In conclusion, our findings may suggest that over two-thirds of patients with clinically suspected myocarditis following COVID-19 vaccination meet the LLC. COVID-19 vaccine-associated myocarditis may show a similar pattern compared to other acute myocarditis entities. Notably, preserved LVEF is probably a common finding in these patients. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Parham Samimisedeh
- Cardiovascular Research CenterAlborz University of Medical SciencesKarajIran
| | | | | | - Hadith Rastad
- Non‐communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
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Matar RH, Mansour R, Nakanishi H, Smayra K, El Haddad J, Vankayalapati DK, Daniel RS, Tosovic D, Than CA, Yamani MH. Clinical Characteristics of Patients with Myocarditis following COVID-19 mRNA Vaccination: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:4521. [PMID: 35956137 PMCID: PMC9369856 DOI: 10.3390/jcm11154521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022] Open
Abstract
COVID-19 mRNA vaccinations have recently been implicated in causing myocarditis. Therefore, the primary aim of this systematic review and meta-analysis was to investigate the clinical characteristics of patients with myocarditis following mRNA vaccination. The secondary aims were to report common imaging and laboratory findings, as well as treatment regimes, in these patients. A literature search was performed from December 2019 to June 2022. Eligible studies reported patients older than 18 years vaccinated with mRNA, a diagnosis of myocarditis, and subsequent outcomes. Pooled mean or proportion were analyzed using a random-effects model. Seventy-five unique studies (patient n = 188, 89.4% male, mean age 18-67 years) were included. Eighty-six patients had Moderna vaccines while one hundred and two patients had Pfizer-BioNTech vaccines. The most common presenting symptoms were chest pain (34.5%), fever (17.1%), myalgia (12.4%), and chills (12.1%). The most common radiologic findings were ST-related changes on an electrocardiogram (58.7%) and hypokinesia on cardiac magnetic resonance imaging or echocardiography (50.7%). Laboratory findings included elevated Troponin I levels (81.7%) and elevated C-reactive protein (71.5%). Seven patients were admitted to the intensive care unit. The most common treatment modality was non-steroid anti-inflammatory drugs (36.6%) followed by colchicine (28.5%). This meta-analysis presents novel evidence to suggest possible myocarditis post mRNA vaccination in certain individuals, especially young male patients. Clinical practice must therefore take appropriate pre-cautionary measures when administrating COVID-19 mRNA vaccinations.
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Affiliation(s)
- Reem H. Matar
- Faculty of Medicine, St George’s University of London, London SW17 0RE, UK; (R.M.); (H.N.); (K.S.); (J.E.H.); (D.K.V.); (R.S.D.); (C.A.T.)
- Faculty of Medicine, University of Nicosia Medical School, University of Nicosia, Nicosia 2417, Cyprus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rania Mansour
- Faculty of Medicine, St George’s University of London, London SW17 0RE, UK; (R.M.); (H.N.); (K.S.); (J.E.H.); (D.K.V.); (R.S.D.); (C.A.T.)
- Faculty of Medicine, University of Nicosia Medical School, University of Nicosia, Nicosia 2417, Cyprus
| | - Hayato Nakanishi
- Faculty of Medicine, St George’s University of London, London SW17 0RE, UK; (R.M.); (H.N.); (K.S.); (J.E.H.); (D.K.V.); (R.S.D.); (C.A.T.)
- Faculty of Medicine, University of Nicosia Medical School, University of Nicosia, Nicosia 2417, Cyprus
| | - Karen Smayra
- Faculty of Medicine, St George’s University of London, London SW17 0RE, UK; (R.M.); (H.N.); (K.S.); (J.E.H.); (D.K.V.); (R.S.D.); (C.A.T.)
- Faculty of Medicine, University of Nicosia Medical School, University of Nicosia, Nicosia 2417, Cyprus
| | - Joe El Haddad
- Faculty of Medicine, St George’s University of London, London SW17 0RE, UK; (R.M.); (H.N.); (K.S.); (J.E.H.); (D.K.V.); (R.S.D.); (C.A.T.)
- Faculty of Medicine, University of Nicosia Medical School, University of Nicosia, Nicosia 2417, Cyprus
| | - Dilip K. Vankayalapati
- Faculty of Medicine, St George’s University of London, London SW17 0RE, UK; (R.M.); (H.N.); (K.S.); (J.E.H.); (D.K.V.); (R.S.D.); (C.A.T.)
- Faculty of Medicine, University of Nicosia Medical School, University of Nicosia, Nicosia 2417, Cyprus
| | - Rohan Suresh Daniel
- Faculty of Medicine, St George’s University of London, London SW17 0RE, UK; (R.M.); (H.N.); (K.S.); (J.E.H.); (D.K.V.); (R.S.D.); (C.A.T.)
- Faculty of Medicine, University of Nicosia Medical School, University of Nicosia, Nicosia 2417, Cyprus
| | - Danijel Tosovic
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Brisbane 4072, Australia;
| | - Christian A. Than
- Faculty of Medicine, St George’s University of London, London SW17 0RE, UK; (R.M.); (H.N.); (K.S.); (J.E.H.); (D.K.V.); (R.S.D.); (C.A.T.)
- Faculty of Medicine, University of Nicosia Medical School, University of Nicosia, Nicosia 2417, Cyprus
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Brisbane 4072, Australia;
| | - Mohamad H. Yamani
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
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Keshavarz P, Yazdanpanah F, Emad M, Hajati A, Nejati SF, Ebrahimian Sadabad F, Azrumelashvili T, Mizandari M, Raman SS. Myocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 Studies. Tomography 2022; 8:1959-1973. [PMID: 36006062 PMCID: PMC9416085 DOI: 10.3390/tomography8040164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
We reviewed the reported imaging findings of myocarditis in the literature following COVID-19 vaccination on cardiac imaging by a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), and Google Scholar. In total, 532 cases of myocarditis after COVID-19 vaccination were reported (462, 86.8% men and 70, 13.2% women, age range 12 to 80) with the following distribution: Pfizer-BioNTech: 367 (69%), Moderna: 137 (25.8%), AstraZeneca: 12 (2.3%), Janssen/Johnson & Johnson: 6 (1.1%), COVAXIN: 1 (0.1%), and unknown mRNA vaccine: 9 (1.7%). The distribution of patients receiving vaccine dosage was investigated. On cardiac MR Imaging, late intravenous gadolinium enhancement (LGE) was observed mainly in the epicardial/subepicardial segments (90.8%, 318 of 350 enhancing segments), with the dominance of inferolateral segment and inferior walls. Pericardial effusion was reported in 13.1% of cases. The vast majority of patients (94%, 500 of 532) were discharged from the hospital except for 4 (0.7%) cases. Post-COVID-19 myocarditis was most commonly reported in symptomatic men after the second or third dose, with CMRI findings including LGE in 90.8% of inferior and inferolateral epicardial/subepicardial segments. Most cases were self-limited.
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Affiliation(s)
- Pedram Keshavarz
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (P.K.); (S.S.R.)
- School of Science and Technology, The University of Georgia, Tbilisi 0171, Georgia
| | - Fereshteh Yazdanpanah
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz 5166, Iran;
| | - Maryam Emad
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | - Azadeh Hajati
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | - Seyed Faraz Nejati
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | | | - Tamta Azrumelashvili
- Department of Diagnostic & Interventional Radiology, New Hospitals Ltd., Tbilisi 0114, Georgia;
| | - Malkhaz Mizandari
- Department of Diagnostic & Interventional Radiology, New Hospitals Ltd., Tbilisi 0114, Georgia;
| | - Steven S. Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (P.K.); (S.S.R.)
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Behers BJ, Patrick GA, Jones JM, Carr RA, Behers BM, Melchor J, Rahl DE, Guerriero TD, Zhang H, Ozkardes C, Thomas ND, Sweeney MJ. Myocarditis Following COVID-19 Vaccination: A Systematic Review of Case Reports. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:237-247. [PMID: 35782472 PMCID: PMC9235262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: COVID-19, the infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), often presents with a spectrum of symptoms at varying levels of severity, ranging from asymptomatic patients to those with fatal complications, such as myocarditis. With increased availability of COVID-19 vaccines, the awareness of possible side effects has expanded as reports surface. This study reviewed cases of myocarditis following COVID-19 vaccination and with existing literature on COVID-19 infection-induced myocarditis to compare clinical courses and analyze possible mechanisms of action. Methods: A systematic review of literature was conducted to identify published case reports (as of February 3, 2022) pertaining to the development of myocarditis following COVID-19 vaccination with either Pfizer or Moderna for an in-depth analysis. Additional subgroup analyses were conducted based on age, past medical history, vaccine manufacturer, and dose number. Results: There were 53 eligible case reports that were included in this study. Patients were mostly male with a median age of 24 years, and the most reported symptom upon presentation was chest pain. Seventy percent of the cases involved the Pfizer vaccine with a majority of myocarditis developing subsequent to second dose. Resolution of symptoms was achieved in all but one patient. Clinical severity, as measured primarily by left ventricular ejection fraction, appeared to be worse among adult patients than pediatric, as well as for patients with comorbidities. Conclusion: This study revealed an observable association between COVID-19 vaccines and myocarditis. However, the clinical course and prognosis seem favorable and less prevalent than those conferred from natural infection.
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Affiliation(s)
| | | | - Jared M. Jones
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | - Rachel A. Carr
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | - Brett M. Behers
- University of South Florida College of Medicine, Tampa,
FL, USA
| | - Julian Melchor
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | - Delaney E. Rahl
- Florida State University College of Medicine,
Tallahassee, FL, USA
| | | | - Hongyu Zhang
- Florida State University College of Medicine,
Tallahassee, FL, USA
- University of South Florida College of Medicine, Tampa,
FL, USA
| | - Cuneyt Ozkardes
- Florida State University College of Medicine,
Tallahassee, FL, USA
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Tozinameran. REACTIONS WEEKLY 2022. [PMCID: PMC9226783 DOI: 10.1007/s40278-022-18125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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