Long-term follow-up of young people with COVID-19 vaccine myocarditis

In a recently published study in immunityThe researchers examined a comprehensive set of outcomes in patients diagnosed with myocarditis after vaccination against coronavirus disease 2019 (COVID-19) in the United States (US). They followed these adolescents and young male patients after they received a messenger ribonucleic acid (mRNA) platform-based COVID-19 vaccine for at least 90 days after the onset of myocarditis.

background

As of July 2022, the US Vaccine Adverse Events Reporting System (VAERS) had reports of over 1,500 cases of myocarditis starting after mRNA COVID-19 vaccination. Systemic studies indicated that the risk of myocarditis was highest in adolescents and young men after a second dose of vaccine. In most cases, however, symptoms disappeared shortly after discharge from a short hospital stay. However, there is little evidence of medium-term prognosis for adolescents and young adults diagnosed with myocarditis following mRNA-COVID-19 vaccination.

About the study

The present study used a two-part telephone survey to assess patients’ myocarditis outcomes between August 24, 2021 and January 12, 2022.

The first survey component assessed quality of life (QoL), history, and myocarditis drug needs. In addition, two weeks before the survey date, they were asked about their clinical symptoms or absences from work. These clinical symptoms included chest pain, shortness of breath, fatigue, palpitations, hospitalization, and missed school or work in the two weeks prior to the survey.

After the myocarditis diagnosis, they assessed the patient’s health status on five parameters – self-care, pain, mobility, ability to perform daily activities, and anxiety or depression, using the EuroQol 5-dimension, 5-level questionnaire (EQ-5D-5L ). . Researchers compared patients’ EQ-5D-5L survey responses to published EQ-5D-5L survey responses. It helped them understand how these responses differed before and during the COVID-19 pandemic.

The QoL questionnaire had five answer levels in which the patients could give dichotomized answers. Grade 1 indicated no problem, while grades 2-5 indicated the number ‘n’ of clinical symptoms of myocarditis. The patient self-assessed his general health using the EuroQol Visual Analogue Scale (EQ-VAS). Scores ranged from 0 to 100, indicating the worst and best health, respectively.

The second survey component determined the patient’s cardiac health and functional status. Follow-up cardiac evaluation included cardiac biomarkers, cardiac magnetic resonance imaging (MRI), echocardiograms, troponin levels, exercise stress testing, ambulatory rhythm monitoring, and electrocardiograms (ECGs). The healthcare providers informed the researchers about the patient’s recovery status for cardiac or myocarditis. They also informed the researchers whether these patients had previously been infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The team compared the demographic and clinical characteristics of survey participants to those of non-participants. In addition, they compared their healthcare provider, geographic census region, age, gender, initial ECG results, and race/ethnicity. Finally, researchers performed descriptive analyzes to determine frequencies, percentages, means, and standard deviations (SDs) to characterize myocarditis cases.

study results

Researchers analyzed 519 patients aged 12 to 29 years who met a predefined case definition for myocarditis according to Centers for Disease and Prevention criteria. Of the 393 patients with a healthcare provider assessment, 320 had recovered from myocarditis and their QoL measurements were similar to pre-pandemic and better than the QoL measurements of the general US population. However, no diagnostic tests or clinical symptoms appeared to be related to the status of recovery.

Fewer patients with myocarditis reported anxiety or depression than individuals during the pandemic (46% vs. 60.2%). In addition, almost 1% of patients had the same cardiac status as when myocarditis was initially diagnosed. Consistent with this finding, another recent report showed better outcomes in vaccine-related COVID-19 myocarditis and faster heart recovery in those under the age of 21.

In a small subset of 151 patients, initial cardiac MRI was normal at diagnosis; however, follow-up MRI was abnormal in 54% of participants. Of 151 patients, 71 patients had residual late gadolinium enhancement, indicating myocardial scarring on cardiac MRI follow-up. A possible explanation is that the clinical findings in these patients continued to evolve after diagnosis. Another reason could be that different healthcare providers performed the initial and subsequent cardiac imaging and arrived at different interpretations.

Conclusions

The study showed that although myocarditis was rare after mRNA-COVID-19 vaccination, those who suffered from it had potentially serious manifestations. Health care providers assumed that most patients recovered within 90 days; Still, nearly 50% of them reported chest pain, of which 25% required heart medication prescriptions. Therefore, continuous monitoring and assessment of myocarditis are required after mRNA-COVID-19 vaccination.