Myocarditis following <scp>COVID</scp>‐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
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- Bettina Heidecker
- Cardiology, Campus Benjamin Franklin, Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt Universität zu Berlin Berlin Germany
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- Noa Dagan
- Clalit Health Services Clalit Research Institute Ramat Gan Israel
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- Ran Balicer
- Clalit Health Services Clalit Research Institute Ramat Gan Israel
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- Urs Eriksson
- Department of Internal Medicine, Division of Cardiology, GZO ‐ Zurich Regional Health Center Wetzikon & University of Zurich Zurich Switzerland
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- Giuseppe Rosano
- St. Georges Medical University of London London UK
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- Andrew Coats
- Monash University Melbourne Victoria Australia
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- Carsten Tschöpe
- Cardiology, German Heart Center Charité – University Medicine Berlin Germany
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- Sebastian Kelle
- Cardiology, German Heart Center Charité – University Medicine Berlin Germany
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- Gregory A. Poland
- Mayo Clinic Rochester MN USA
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- Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences La Sapienza University Rome Italy
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- Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology University Hospital Tübingen Tübingen Germany
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- Pilar Martin
- Cientro Nacional de Investigationes Cardiovasculares Madrid Spain
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- Joshua M. Hare
- Interdisciplinary Stem Cell Institute University of Miami Miami FL USA
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- Leslie T. Cooper
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA, and Cardiology Mayo Clinic Jacksonville Jacksonville FL USA
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- Antonis Pantazis
- Royal Brompton and Harefield Hospitals and Imperial College London London UK
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- Massimo Imazio
- Cardiothoracic Department, Cardiology Udine University Health Integrated Agency Udine Italy
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- Sanjay Prasad
- Royal Brompton and Harefield Hospitals and Imperial College London London UK
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- Thomas F. Lüscher
- Royal Brompton and Harefield Hospitals and Imperial College London London UK
抄録
<jats:title>Abstract</jats:title><jats:p>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</jats:p><jats:p>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.</jats:p>
収録刊行物
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- European Journal of Heart Failure
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European Journal of Heart Failure 24 (11), 2000-2018, 2022-10-06
Wiley