Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series
Abstract
:1. Introduction
2. Results
3. Discussion
Study Limitations
4. Materials and Methods
4.1. Patients and Clinical Investigations
4.2. Molecular Virology of EMBs
4.3. Histology, Immunohistochemistry and Digital Imaging Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Pat. No. | Sex | Age (y) | LVEF (%) | Vaccine | Manufacturer | Dose | Onset of Symptoms (Days) | Clinical Picture | Troponin (pg/mL) Normal <15 | BNP (pg/mL) Normal <125 | CK (U/L) Normal <171 | CRP (mg/dL) Normal <0.5 | Suspected Diagnosis | Diagnosis |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | m | 23 | 45 | Comirnaty | Pfizer-BioNTech | 2nd | 20 | discomfort during exercise, reduced LVEF, dilated LV | <15 | <0.5 | AMC; myocarditis after vaccination | AMC | ||
2 | f | 31 | 20 | Comirnaty | Pfizer-BioNTech | 2nd | 0 | cardiac arrest during sports 6 h after the 2nd vaccination, resuscitation, dyspnea, hopotonia, reduced LVEF, dilated LV, NYHA III, intrapulmonary infiltrates, pericardial effusion, no signs of active myocarditis in cMRI | 1325 | 2183 | 784 | 7.3 | AMC; myocarditis after vaccination | AMC |
3 | m | 32 | 43 | Comirnaty | Pfizer-BioNTech | 1st | 1–3 | dyspnea, reduced exercise capacity, reduced LVEF, NYHA II | 576 | 2483 | 8.9 | AMC; myocarditis after vaccination | GCMC | |
4 | m | 52 | 45 | Comirnaty | Pfizer-BioNTech | 2nd | 3 | inpatient admission after resuscitation for ventricular fibrillation, reduced LVEF, LV latero-apical akinesia with wall thinning, no signs of active myocarditis in cMRI | 436 | 2.8 | ARVC; myocarditis after vaccination | DCMi | ||
5 | m | 18 | 12 | Comirnaty | Pfizer-BioNTech | 2nd | 21 | cardiac decompensation, reduced LVEF, NYHA II-III, no signs of active myocarditis in cMRI | 38.1 | 8430 | 181 | 0.7 | DCM; myocarditis after vaccination | DCMi |
6 | m | 59 | 38 | Comirnaty | Pfizer-BioNTech | 2nd | 56 | dyspnea, reduced LVEF | 58.3 | 669 | myocarditis after vaccination | DCMi | ||
7 | m | 24 | 30 | Comirnaty | Pfizer-BioNTech | 2nd | 2 | dyspnea, angina pectoris, reduced LVEF | 710 | 585 | 9.3 | AMC; myocarditis after vaccination | DCMi | |
8 | m | 39 | 5 | Comirnaty | Pfizer-BioNTech | 2nd | 4 | dyspnea, cardiac decompensation, reduced LVEF, signs of active myocarditis in cMRI | 935 | 68 | 1.47 | AMC; myocarditis after vaccination | DCMi | |
9 | m | 34 | 10 | Comirnaty | Pfizer-BioNTech | 1st | 14 | dyspnea, reduced exercise capacity, reduced LVEF, dilated LA, supraventricular tachycardia up to 140/min, atrial fibrillation, myocardial edema and signs of active myocarditis in cMRI | <15 | AMC; myocarditis after vaccination | DCMi | |||
10 | f | 38 | 40 | Comirnaty | Pfizer-BioNTech | 2nd | 14 | reduced LVEF, NYHA I | <15 | 84 | 35 | 2.8 | AMC; myocarditis after vaccination | DCMi |
11 | f | 52 | 15 | Comirnaty | Pfizer-BioNTech | 2nd | 1 | dyspnea on exertion, reduced LVEF, mitral valve insufficiency, hypertension, no signs of active myocarditis in cMRI | 1592 | 83 | 7.1 | AMC; myocarditis after vaccination | DCMi | |
12 | f | 59 | 37 | Vaxzevria | AstraZenica | 2nd | 14 | dyspnea, reduced LVEF | <15 | myocarditis after vaccination | DCM | |||
13 | f | 68 | 30 | Vaxzevria | AstraZenica | 1st | 1 | reduced LVEF | 582 | 1094 | AMC; DCMi; myocarditis after vaccination | DCMi | ||
14 | f | 31 | 35 | Janssen | Johnson & Johnsen | 1st | 28 | fulminant cardiogenic shock, reduced LVEF | 48 | 334 | 1557 | 35 | AMC; GCMC; Sarkoidosis; myocarditis after vaccination | GCMC |
15 | m | 45 | 10 | Janssen | Johnson & Johnsen | 1st | 14 | dyspnea, reduced LVEF, dilated LV, atrial fibrillation | 23.7 | 1670 | 90 | 1.4 | AMC; myocarditis after vaccination | DCMi |
Pat. No. | Vaccine | Diagn. | Ventr. | Virology | CD3 (Cells/mm2) Normal <14 | CD45R0 (Cells/mm2) Normal <60 | LFA-1 (Cells/mm2) Normal <14 | MAC-1 (Cells/mm2) Normal <40 | Perforin (Cells/mm2) Normal <3.5 | HLA-DR (Area%) Normal <4.6 | ICAM-1 (Area%) Norma <2.8 | VCAM-1 (Area%) Normal <0.08 | CD4 to CD8 Ratio | SARS-CoV-2 Spike Protein |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Comirnaty | AMC | RV | B19V | 11.3 | 33.0 | 17.2 | 34.7 | 1.1 | 4.7 | 2.2 | 0.02 | 0.7 | - |
2 | Comirnaty | AMC | LV | - | 500 | 749 | 501 | 277 | 0.0 | 6.2 | 4.8 | 0.61 | 0.2 | + |
3 | Comirnaty | GCMC | LV | - | 274 | 682 | 439 | 80.6 | 0.0 | 12.7 | nd | nd | 0.7 | + |
4 | Comirnaty | DCMi | LV | B19V | 52.1 | 132.6 | 45.4 | 86.5 | 0.0 | 5.6 | 0.3 | 0.01 | 2.0 | - |
5 | Comirnaty | DCMi | LV | B19V | 4.8 | 51.6 | 18.3 | 38.3 | 0.0 | 3.4 | 0.7 | 0.01 | 1.0 | + |
6 | Comirnaty | DCMi | LV | B19V | 17.9 | 67.3 | 6.7 | 38.1 | 0.0 | 3.8 | nd | nd | 7.4 | - |
7 | Comirnaty | DCMi | LV | - | 21.4 | 110 | 95.5 | 53.3 | 0.0 | 5.0 | 2.1 | 0.04 | 1.0 | + |
8 | Comirnaty | DCMi | LV | B19V | 18.3 | 153 | 24.8 | 108 | 0.0 | 6.6 | 0.7 | 0.02 | 2.8 | - |
9 | Comirnaty | DCMi | RV | B19V | 48.7 | 62.2 | 72.8 | 84.3 | 0.0 | 8.0 | 2.2 | 0.02 | 0.6 | - |
10 | Comirnaty | DCMi | LV | B19V | 7.1 | 79.8 | 21.9 | 54.4 | 0.0 | 4.4 | nd | nd | 11.2 | + |
11 | Comirnaty | DCMi | RV | B19V | 10.5 | 76.7 | 28.4 | 61.3 | 2.5 | 8.2 | nd | nd | 1.0 | + |
12 | Vaxzevria | DCM | RV | B19V | 2.9 | 31.4 | 8.8 | 28.6 | 0.0 | 2.9 | 0.6 | 0.00 | 1.0 | + |
13 | Vaxzevria | DCMi | LV | - | 13.4 | 114 | 13.4 | 81.3 | 1.8 | 12.3 | nd | nd | 12.4 | + |
14 | Janssen | GCMC | LV | - | 800 | 987 | 713 | 360 | 0.0 | 23.1 | 6.4 | 0.37 | 0.6 | nd |
15 | Janssen | DCMi | RV | B19V | 52.9 | 108 | 54.0 | 100 | 0.0 | 8.0 | 3.7 | 0.06 | 1.0 | + |
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Baumeier, C.; Aleshcheva, G.; Harms, D.; Gross, U.; Hamm, C.; Assmus, B.; Westenfeld, R.; Kelm, M.; Rammos, S.; Wenzel, P.; et al. Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series. Int. J. Mol. Sci. 2022, 23, 6940. https://doi.org/10.3390/ijms23136940
Baumeier C, Aleshcheva G, Harms D, Gross U, Hamm C, Assmus B, Westenfeld R, Kelm M, Rammos S, Wenzel P, et al. Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series. International Journal of Molecular Sciences. 2022; 23(13):6940. https://doi.org/10.3390/ijms23136940
Chicago/Turabian StyleBaumeier, Christian, Ganna Aleshcheva, Dominik Harms, Ulrich Gross, Christian Hamm, Birgit Assmus, Ralf Westenfeld, Malte Kelm, Spyros Rammos, Philip Wenzel, and et al. 2022. "Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series" International Journal of Molecular Sciences 23, no. 13: 6940. https://doi.org/10.3390/ijms23136940