AUTHOR=Pedersen Anders Lehmann Dahl , Wood Gregory , Frederiksen Christian Alcaraz , Løgstrup Brian Bridal , Jensen Morten Kvistholm , Østergaard Lars , Kim Won Yong , Poulsen Steen Hvitfeldt 

TITLE=Clinical presentation and cardiac imaging findings in patient cases of perimyocarditis and pericarditis with a temporal association to SARS-CoV-2 vaccination

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.964412

DOI=10.3389/fcvm.2022.964412

ISSN=2297-055X

ABSTRACT=Aims. We aimed to investigate and present cases of perimyocarditis and pericarditis verified by cardiovascular resonance (CMR) imaging in patients with a strong temporal association to SARS-CoV-2 vaccination. We sought to describe the clinical presentation including coronary artery angiography, CMR, transthoracic echocardiography, blood samples, electrocardiography, and symptoms.

Methods. We included 12 patients who were admitted with chest pain shortly after vaccination for SARS-CoV-2, who were diagnosed with pericarditis or perimyocarditis by CMR. We reviewed the CMR, echocardiography, electrocardiography, blood samples, coronary angiography, vital signs and medical history. The updated Lake Louise Criteria were used to determine the diagnosis by CMR. 

Results. Ten patients had perimyocarditis and two patients had pericarditis. The mean age was 22 ± 4 years (range 16 to 31 years), 92% were male. The median time from vaccination to hospital admission was 4 days (range 2 to 28 days). Admissions were seen after vaccination with three different SARS-CoV-2 vaccine manufacturers. 10 Patients had ST-elevation on the initial electrocardiography. Peak troponins varied from 7 ng/l to 23547 ng/l, with a median of 3653 ng/l. Two patients had an LVEF <50% on echocardiography and four patients had absolute left ventricular global longitudinal strain values <18%. CMR revealed preserved left ventricular ejection fraction (LVEF), although one patient had decreased LVEF on CMR. The T1 and T2 mapping values were increased in all patients. Of the 10 patients with perimyocarditis, all patients had signs of myocardial injury in the lateral wall of the left ventricle.

Conclusions. This case series of 12 patients supports the emerging evidence of an association between vaccination for SARS-CoV-2 and perimyocarditis and pericarditis, especially in young males. The temporal association was seen after vaccines from three different manufacturers. Imaging data from echocardiography and CMR displayed normal to mildly impaired cardiac function, usually with a mild disease course.