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Review

Myocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 Studies

by
Pedram Keshavarz
1,2,
Fereshteh Yazdanpanah
3,
Maryam Emad
4,
Azadeh Hajati
4,
Seyed Faraz Nejati
4,
Faranak Ebrahimian Sadabad
4,
Tamta Azrumelashvili
5,
Malkhaz Mizandari
5,* and
Steven S. Raman
1
1
Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
2
School of Science and Technology, The University of Georgia, Tbilisi 0171, Georgia
3
Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz 5166, Iran
4
Taba Medical Imaging Center, Shiraz 71347-53151, Iran
5
Department of Diagnostic & Interventional Radiology, New Hospitals Ltd., Tbilisi 0114, Georgia
*
Author to whom correspondence should be addressed.
Tomography 2022, 8(4), 1959-1973; https://doi.org/10.3390/tomography8040164
Submission received: 2 June 2022 / Revised: 19 July 2022 / Accepted: 25 July 2022 / Published: 30 July 2022
(This article belongs to the Section Cardiovascular Imaging)

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.

1. Introduction

To mitigate the COVID-19 pandemic, mass vaccination of the general population commenced in December 2020 across the developed world. As of 7 March 2022, more than 60% of the world’s population has received at least one dose of several vaccines [1,2,3,4]. Widespread vaccination and other measures have resulted in decreased rates of COVID-19 incidence, severity, morbidity, and mortality [5]. However, vaccine-related side effects have been reported, including pain, redness, swelling or lymphadenopathy at or around the injection site, fever, fatigue, headache, muscle pain, nausea, vomiting, itching, chills, joint pain, and anaphylactic shock [4,6]. Recently, myocarditis has also been reported following the COVID-19 vaccination [7,8,9] with findings of impaired cardiac function detected clinically on electrocardiogram, echocardiogram, chest radiograph (CXR), contrast-enhanced chest computed tomography (CCT), contrast-enhanced coronary computed tomography angiography (CCTA), and gadolinium-enhanced cardiac magnetic resonance imaging (CMRI) [10,11,12]. The purpose of this study is to review the reported imaging findings of myocarditis after COVID-19 vaccination, stratified by vaccine type and imaging findings.

2. Methods

2.1. Search Strategy

We reviewed the literature initially on 23 July 2021, with an updated review on 10 March 2022, to identify all imaging studies reporting myocarditis after vaccination with any United States Food and Drug Administration (FDA) or World Health Organization (WHO) approved COVID-19 vaccine worldwide. All English language databases, including PubMed (MEDLINE), Scopus, Web of Science, Embase (Elsevier), and Google Scholar, were searched. The keywords search and medical subject headings (MeSH) were used: ‘Coronavirus’, ‘COVID-19’, ‘SARS-CoV-19’, ‘COVID-19 vaccination’, ‘Vaccine*’ ‘Post vaccine’, ‘Vaccination side effect’, and ‘Myocarditis’. The search strategy of the Medline database is presented in an Appendix A.

2.2. Eligibility Criteria

All reported English language studies reported cardiac imaging findings of patients who received one or more doses of FDA- or WHO-approved types of COVID-19 vaccines, including Pfizer-BioNTech, Moderna, AstraZeneca, Janssen/Johnson & Johnson, and COVAXIN vaccine; with the clinical, laboratory, and at least one imaging presentation of myocarditis by different imaging modalities such as CXR, echocardiography, CCT scan, CCTA, and CMRI, were included in the study. Conference abstracts, duplicate studies, reviews, and non-English languages were excluded from the study.

2.3. Data Extraction and Synthesis

Two radiologists independently extracted the following data from the included studies and then cross-checked the results. A third reviewer (radiologist with 23 years of experience) resolved disagreements via consensus. The following data were extracted: the name of the first author, study’s region, study design, patient’s characteristic, type of COVID-19 vaccine, number of doses, the clinical and laboratory findings of myocarditis following vaccination, electrocardiographic (ECG) findings, echocardiographic findings, imaging findings (echocardiography, cardiac CT, CCTA, CMRI), and patient outcome. Meanwhile, most of the CMR findings in included studies were fulfilled based on the revised Lake Louise Criteria (LLC), including the appearance of at least one T1 (increased myocardial T1 relaxation times, extracellular volume fraction, or LGE) and T2-based criterion (increased myocardial T2 relaxation times, visible myocardial edema, or increased T2 signal intensity ratio) Additionally, we reported images of four vaccinated cases [8,13,14,15] presenting with myocarditis with abnormal cardiac MRI findings following COVID-19 vaccination after obtaining formal permission (Figure 1, Figure 2, Figure 3 and Figure 4).

3. Results

3.1. Literature Search

From the initial literature review, a total of 654 studies were derived and after removing duplicates, title and abstract screening were performed on 389 remaining studies. Finally, 118 studies were selected and identified as candidates for investigation based on our inclusion criteria. The flow diagram of the study selection process is presented in Figure 5.

3.2. Patients’ Characteristics

We derived 532 post-vaccine cases of CT or MR findings of myocarditis, including 462 (86.8%) males and 70 (13.2%) females (age range: 12–80 years). In total, 113 (21.2%) cases had positive disease history or comorbidities, presented in Table 1.

3.3. Clinical and Laboratory Findings

The most common reported symptoms were chest discomfort or substernal/positional chest pain (n = 429, 80.6%) and fever with or without chills in 245 (46%) cases. The clinical presentation/onset of symptoms after vaccination was not reported in 167 (31.4%) cases. In the study cohort, most cases (69%, 367 of 532 cases) injected Pfizer-BioNTech, followed by Moderna in 137 (25.8%) cases. In total, 62 (11.6%) cases received the first vaccine dose, 333 (62.6%) cases received two vaccine doses, and 7 cases received the third (booster) dose (Table 1 and Supplementary Table S1).

3.4. Presentation Date

The interval between vaccination date and symptoms was reported in 501 patients from 108 studies, of which 97 reported exact dates and 9 reported a range of days in the presentation interval. Meanwhile, the median interval of presentation days after vaccination in Pfizer-BioNTech, Moderna, AstraZeneca, Janssen/Johnson & Johnson, COVAXIN, and unknown mRNA vaccines were 3 (0–90), 3 (0–46), 6 (1–19), 4 (2–5), 8 (0–8), and 2 (0–20) days, respectively, in 297 cases (from 97 of 118 studies). In addition, eleven studies comprising 204 patients reported a median range of presentation days between 1 and 96 days. In almost all studies, concurrent COVID-19 infection was investigated by polymerase chain reaction (PCR) and antibodies lab findings of cases, resulting in negative results. Most patients were discharged from the hospital uneventfully. There were three reported deaths and one readmission following the post-COVID-19 vaccination myocarditis event. In other cases, the outcome was not reported (Table 1). The first reported death was a 42-year-old male who presented two weeks after the second dose of Moderna vaccine with an ejection fraction of 15% on echocardiography, without coronary artery disease (CAD), and died three days following hospitalization due to cardiogenic collision. On post-mortem, histological examination inflammatory exudates confirmed the myocarditis diagnosis. The second reported death was a 70-year-old female with multiple sclerosis, hospitalized two days after the Janssen/Johnson & Johnson vaccine with an ejection fraction (10%) and diffuse left ventricular hypokinesis. She died eight days after admission due to cardiogenic shock and renal failure. The third reported death was in a 62-year-old woman with melanoma who received the Janssen/Johnson & Johnson vaccine four days before presentation. The patient died after numerous advanced cardiovascular life support attempts due to a critically depressed ejection fraction.

3.5. Imaging Findings

In the 532 cases, imaging findings were reported using different imaging methods. Chest radiography (CXR) findings were reported in 43 of 532 (8.1%) cases, of which 6 out of 43 reported abnormalities, including pulmonary edema, cardiomegaly, congestion, and pleural effusion.

3.5.1. CMRI and CCTA

The principal diagnostic imaging method of post-COVID-19 vaccine-related myocarditis reported in all 532 cases was CMRI, with abnormal findings in 361 (67.8%) cases. Abnormal findings included myocardial edema 188 (35.3%), patchy or global myocardial signal hyperintensity in T1-weighted 142 (26.7%) and T2-weighted images 150 (28.2%), and pericardial, epicardial, and subepicardial LGE (overall 234, 44%), which all suggest a diagnosis of myocarditis. LGE of cardiac MRI was observed mainly on the epicardial/subepicardial segments (318 of 350 locations of enhancement, 90.8%) with the involvement of the inferior and inferolateral walls. Moreover, septal involvement was scanty. (Table 2)

3.5.2. Echocardiography

Echocardiography was reported in 73% (388 of 532) of cases with normal findings in 228 cases. Abnormal echocardiographic findings in 41.2% (160 of 388) of cases included pericardial effusion 5.1% (20 of 388), focal and general hypokinesia 12.1% (47 of 388), reduction in mono or biventricular ejection fraction 21.9% (85 of 388), and others were not reported. The left ventricle ejection fraction (LVEF) was reported in 197 cases of which 32% (63 of 197) were less than 50% and 68% (134 of 197) cases were greater than 50% (Supplementary Table S2).

4. Discussion

The COVID-19 vaccines have successfully mitigated the pandemic and decreased the transmission and severity of the disease, with few reported side effects such as myocarditis [16,17]. In this literature review, most patients with COVID-19 vaccine myocarditis were symptomatic men who presented mainly after the second or booster vaccine dose of mRNA vaccines and recovered rapidly. However, there are other cases with non-mRNA vaccines, unlike the last two studies [18,19] On CMRI, LGE reported mainly on the epicardial/subepicardial segments (90.8%) with the involvement of the inferior and inferolateral walls. Pericardial effusion was reported in the area of enhancement in around 13% of cases.
The incidence of post-vaccine myocarditis has been reported with many different vaccines, especially the smallpox vaccine [20,21,22,23]. Following the first report of post-COVID-19 vaccination myocarditis from the Israeli Ministry of Health, other reports were published [24,25].
The United States Centers for Disease Control (CDC) estimated that the risk of myocarditis among hospitalized patients was more than 15 times higher for patients with COVID-19 than those without COVID-19 infection [26]. Although the hallmark of myocarditis is inflammation in the myocytes on a myocardial biopsy, this is invasive, morbid and requires expertise. Non-invasive serum inflammatory factors and cardiac markers, ECG, and echocardiography modalities may be useful in the diagnosis of myocarditis [12,23,27]. CMRI, with its ability to resolve separate myocardial tissues and their composition, is considered the best non-invasive test due to its high specificity and sensitivity compared with other imaging modalities [28].
The diagnostic imaging criteria of myocarditis on CMRI include the appearance of at least one T1- and T2-based criterion according to the revised LLC [29,30]. In the present review, most included studies described LLC criteria such as myocardial signal hyperintensity and LGE as the dominant imaging findings in their cases. However, in an earlier study by Shiyovich et al., CMR imaging results were not compatible with the updated Lake Louise criteria for the early diagnosis of myocarditis; most of our reviewed cases had one or more updated LLC criteria that may fulfill them [19].
The earliest sign of myocarditis is myocardial edema associated with underlying inflammation. This finding can be detected mainly as T2 hyper signal areas in the myocardium; blood flow increases in inflamed tissue, which can be seen as an early enhancement [31]. These two early CMRI imaging findings are seen before other modalities could show signs of myocarditis, mostly changes in anatomical findings requiring more time (e.g., increased myocardial thickness or decreased ejection fraction in echocardiography and cardiomegaly, and increased vascularity in chest X-ray) [32].
Another CMRI finding which could be evaluated is the time and severity of the pathology (acute or subacute phase), as delayed enhancement is seen in fibrotic and necrotic changes. The main drawback of CMRI is its limited availability to secondary or tertiary centers mainly in the developed world. Imaging and non-imaging findings of other modalities, which are nonspecific signs of acute heart failure, should be evaluated in a clinical scenario in post-COVID-19 vaccinated patients presenting with symptoms.
Albert et al. [33] reported that a previously healthy 24-year-old man presented with chest pain that had worsened several days following his second dose of the Moderna COVID-19 vaccine. In workup, besides elevated serum inflammatory factors and troponin I, CMRI myocarditis findings meeting LLC included patchy mid-myocardial and epicardial LGE, normal LV size, and EF (58%), with superimposed edema. Rosner et al. [34] reported several different post-COVID-19 vaccine myocarditis cases.
One of the hypotheses about this appearance, due to intensified awareness of multi-system inflammatory syndrome in children (MIS-C) manifesting with indefinite symptoms, is more frequently assessed with a widespread panel of tests that enhance the sensitivity of identifying episodes of perimyocarditis that might not need intervention [35,36]. The above-mentioned literature presented vaccines’ diversity and prevalence. All imaging findings in various vaccinated cases by different types of vaccine, which complicated with myocarditis, were alike without significant variation. In addition, this review study indicates that this adverse event has happened mainly in adolescents and youthful adults with male gender type.

Limitations

This presented review study has some limitations. First, most included studies did not report the number and proportion of patients with a prior history of COVID-19 infection. Second, some studies did not separately report the second and booster vaccine shots, so we cannot consider separating the second from the booster dose under vaccination status.

5. Conclusions

In most reported cases of post-COVID-19 vaccination-related myocarditis on CMRI, LGE was observed mainly in the epicardial/subepicardial segments, with the involvement of inferolateral and inferior walls with pericardial effusion in the area of enhancement in 13.1% of cases.

Supplementary Materials

The following are available online at https://www.mdpi.com/article/10.3390/tomography8040164/s1, Table S1: Characteristics of Cases with Myocarditis Following COVID-19 Vaccination (n = 532), Table S2: Cardiac Findings of Cases with Myocarditis Following COVID-19 Vaccination (n = 532). References [7,8,9,13,14,15,16,19,33,34,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144] are cited in the supplementary materials.

Author Contributions

Conceptualization, P.K.; methodology, P.K.; writing—original draft preparation, P.K. and F.Y.; writing—review and editing, F.Y., M.E., T.A., A.H. and M.M.; data curation and visualization: F.E.S. and S.F.N.; Supervision: S.S.R. and M.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Institutional Review Board approval was not required because it was a literature study.

Informed Consent Statement

Informed consent was not required because it was a literature study.

Acknowledgments

The authors would like to thank Ammirati, Habib, Isaak, and Mansour for providing the images for this study and also thank the publisher holder of Radiological Society of North America (RSNA), Elsevier and Copyright Clearance Center, for permission to use the images.

Conflicts of Interest

The authors declare no conflict of interest.

Abbreviations

CMRI: Cardiac magnetic resonance imaging, CCTA: Coronary computed tomography angiography, CAD: Coronary artery disease, LGE: Late gadolinium enhancement, LVEF: Left ventricle ejection fraction, CXR: Chest radiography, LLC: Lake Louise Criteria.

Appendix A

  • Keyword Search Strategy
  • Medline (PubMed)
  • (“coronavirus 2” [Title/Abstract] OR “coronavirus 2” [Mesh] OR “coronavirus infections” [Title/Abstract] OR “coronavirus infections” [Mesh] OR “COVID-19” [Title/Abstract] OR “COVID-19” [Mesh] OR “coronavirus” [Title/Abstract] OR “coronavirus” [Mesh] OR “2019-nCoV” [Title/Abstract] OR “COVID-2019” [Title/Abstract] OR “COVID19” [Title/Abstract] OR “nCoV” [Title/Abstract] OR “coronavirus disease 2019” [Title/Abstract] OR “2019 novel coronavirus” [Title/Abstract] OR “severe acute respiratory syndrome” [Title/Abstract] OR “SARS-CoV-19” [Title/Abstract] OR “SARS-CoV-2” [Title/Abstract] OR “2019-CoV-19” [Title/Abstract] OR “SARS-CoV” [Title/Abstract] OR “2019nCoV” [Title/Abstract] OR “coronavirinae” [Title/Abstract] OR “2019 Novel Coronavirus Infection” [Title/Abstract] OR “2019 nCoV Infection” [Title/Abstract] OR “Bat coronavirus” [Title/Abstract] OR “betacoronavirus*” [Title/Abstract] OR “coronavirus Infection Disease 2019” [Title/Abstract] OR “COVID*” [Title/Abstract] OR “Novel Coronavirus Pneumonia” [Title/Abstract] OR “Wuhan virus” [Title/Abstract]) AND (“Vaccination” [Title/Abstract] OR “Vaccination” [Mesh] OR “Vaccines” [Title/Abstract] OR “Vaccines” [Mesh] OR “Mass Vaccination” [Title/Abstract] OR “Mass Vaccination” [Mesh] OR “Immunization” [Title/Abstract] OR “Immunization” [Mesh] OR “Immunization Programs” [Title/Abstract] OR “Immunization Programs” [Mesh] OR “Vaccination*” [Title/Abstract] OR “Vaccin*” [Title/Abstract] OR “Vaccination program” [Title/Abstract] OR “Vaccine” [Title/Abstract] OR “Vaccine-mediated protection” [Title/Abstract] OR “Post-vaccine” [Title/Abstract] OR “Post vaccine” [Title/Abstract] OR “Vaccination-induced” [Title/Abstract] OR “Post-vaccination” [Title/Abstract] OR “Post vaccination” [Title/Abstract] OR “Immunization*” [Title/Abstract] OR “Pfizer vaccine” [Title/Abstract] OR “Pfizer-BioNTech COVID-19 vaccine” [Title/Abstract] OR “Moderna vaccine” [Title/Abstract] OR “mRNA vaccine” [Title/Abstract] OR “Astra-Zeneca vaccine” [Title/Abstract] OR “anti-SARS-CoV-2 vaccine” [Title/Abstract] OR “BNT162b2 mRNA COVID-19 vaccine” [Title/Abstract]) AND (“Myocarditis” [Title/Abstract] OR “Myocarditis” [Mesh] OR “Myopericarditis” [Title/Abstract] OR “Cardiomayopathy” [Title/Abstract] OR “Pricarditis” [Title/Abstract] OR “Myocardial lesion” [Title/Abstract] OR “acute myocarditis” [Title/Abstract] OR “myocard*” [Title/Abstract] OR “Dilated Cardiomyopathy” [Title/Abstract])

References

  1. Zhu, N.; Zhang, D.; Wang, W.; Li, X.; Yang, B.; Song, J.; Zhao, X.; Huang, B.; Shi, W.; Lu, R.; et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N. Engl. J. Med. 2020, 382, 727–733. [Google Scholar] [CrossRef] [PubMed]
  2. Yazdanpanah, F.; Hamblin, M.R.; Rezaei, N. The immune system and COVID-19: Friend or foe? Life Sci. 2020, 256, 117900. [Google Scholar] [CrossRef] [PubMed]
  3. Centers for Disease Control and Prevention COVID Data Tracker. 2021. Available online: https://covid.cdc.gov/covid-data-tracker/#datatracker-home (accessed on 29 July 2021).
  4. Le, T.T.; Cramer, J.P.; Chen, R.; Mayhew, S. Evolution of the COVID-19 vaccine development landscape. Nat. Rev. Drug Discov. 2020, 19, 667–668. [Google Scholar] [CrossRef]
  5. Thanh Le, T.; Andreadakis, Z.; Kumar, A.; Gómez Román, R.; Tollefsen, S.; Saville, M.; Mayhew, S. The COVID-19 vaccine development landscape. Nat. Rev. Drug Discov. 2020, 19, 305–306. [Google Scholar] [CrossRef]
  6. Keshavarz, P.; Yazdanpanah, F.; Rafiee, F.; Mizandari, M. Lymphadenopathy following COVID-19 Vaccination: Imaging Findings Review. Acad. Radiol. 2021, 28, 1058–1071. [Google Scholar] [CrossRef]
  7. Diaz, G.A.; Parsons, G.T.; Gering, S.K.; Meier, A.R.; Hutchinson, I.V.; Robicsek, A. Myocarditis and Pericarditis after Vaccination for COVID-19. JAMA 2021, 326, 1210–1212. [Google Scholar] [CrossRef] [PubMed]
  8. Isaak, A.; Feisst, A.; Luetkens, J.A. Myocarditis following COVID-19 Vaccination. Radiology 2021, 301, E378–E379. [Google Scholar] [CrossRef] [PubMed]
  9. Nassar, M.; Nso, N.; Gonzalez, C.; Lakhdar, S.; Alshamam, M.; Elshafey, M.; Abdalazeem, Y.; Nyein, A.; Punzalan, B.; Durrance, R.J.; et al. COVID-19 vaccine-induced myocarditis case report with literature review. Diabetes Metab. Syndr. 2021, 15, 102205. [Google Scholar] [CrossRef] [PubMed]
  10. Bangalore, S.; Sharma, A.; Slotwiner, A.; Yatskar, L.; Harari, R.; Shah, B.; Ibrahim, H.; Friedman, G.H.; Thompson, C.; Alviar, C.L.; et al. ST-Segment Elevation in Patients with Covid-19—A Case Series. N. Engl. J. Med. 2020, 382, 2478–2480. [Google Scholar] [CrossRef] [PubMed]
  11. Tajbakhsh, A.; Gheibi Hayat, S.M.; Taghizadeh, H.; Akbari, A.; Inabadi, M.; Savardashtaki, A.; Johnston, T.P.; Sahebkar, A. COVID-19 and cardiac injury: Clinical manifestations, biomarkers, mechanisms, diagnosis, treatment, and follow up. Expert Rev. Anti. Infect. Ther. 2021, 19, 345–357. [Google Scholar] [CrossRef]
  12. Siripanthong, B.; Nazarian, S.; Muser, D.; Deo, R.; Santangeli, P.; Khanji, M.Y.; Cooper, L.T.; Chahal, C.A.A. Recognizing COVID-19–related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020, 17, 1463–1471. [Google Scholar] [CrossRef] [PubMed]
  13. Ammirati, E.; Cavalotti, C.; Milazzo, A.; Pedrotti, P.; Soriano, F.; Schroeder, J.W.; Morici, N.; Giannattasio, C.; Frigerio, M.; Metra, M.; et al. Temporal Relation between Second Dose BNT162b2 mRNA Covid-19 Vaccine and Cardiac involvement in a Patient with Previous SARS-COV-2 Infection. Int. J. Cardiol. Heart Vasc. 2021, 34, 100774. [Google Scholar] [CrossRef] [PubMed]
  14. Habib, M.B.; Hamamyh, T.; Elyas, A.; Altermanini, M.; Elhassan, M. Acute myocarditis following administration of BNT162b2 vaccine. IDCases 2021, 25, e01197. [Google Scholar] [CrossRef] [PubMed]
  15. Mansour, J.; Short, R.G.; Bhalla, S.; Woodard, P.K.; Verma, A.; Robinson, X.; Raptis, D.A. Acute myocarditis after a second dose of the mRNA COVID-19 vaccine: A report of two cases. Clin. Imaging 2021, 78, 247–249. [Google Scholar] [CrossRef] [PubMed]
  16. McLean, K.; Johnson, T.J. Myopericarditis in a previously healthy adolescent male following COVID-19 vaccination: A case report. Acad. Emerg. Med. 2021, 28, 918–921. [Google Scholar] [CrossRef] [PubMed]
  17. Bozkurt, B.; Kamat, I.; Hotez, P.J. Myocarditis with COVID-19 mRNA Vaccines. Circulation 2021, 144, 471–484. [Google Scholar] [CrossRef] [PubMed]
  18. Fazlollahi, A.; Zahmatyar, M.; Noori, M.; Nejadghaderi, S.A.; Sullman, M.J.M.; Shekarriz-Foumani, R.; Kolahi, A.; Singh, K.; Safiri, S. Cardiac complications following mRNA COVID-19 vaccines: A systematic review of case reports and case series. Rev. Med. Virol. 2022, 32, e2318. [Google Scholar] [CrossRef] [PubMed]
  19. Shiyovich, A.; Witberg, G.; Aviv, Y.; Eisen, A.; Orvin, K.; Wiessman, M.; Grinberg, T.; Porter, A.; Kornowski, R.; Hamdan, A. Myocarditis following COVID-19 vaccination: Magnetic resonance imaging study. Eur. Heart J. Cardiovasc. Imaging 2021, 23, jeab230. [Google Scholar] [CrossRef]
  20. Kuntz, J.; Crane, B.; Weinmann, S.; Naleway, A.L.; Vaccine Safety Datalink Investigator Team. Myocarditis and pericarditis are rare following live viral vaccinations in adults. Vaccine 2018, 36, 1524–1527. [Google Scholar] [CrossRef]
  21. Yamamoto, H.; Hashimoto, T.; Ohta-Ogo, K.; Ishibashi-Ueda, H.; Imanaka-Yoshida, K.; Hiroe, M.; Yokochi, T. A case of biopsy-proven eosinophilic myocarditis related to tetanus toxoid immunization. Cardiovasc. Pathol. 2018, 37, 54–57. [Google Scholar] [CrossRef]
  22. Barton, M.; Finkelstein, Y.; Opavsky, M.A.; Ito, S.; Ho, T.; Ford-Jones, L.E.; Taylor, G.; Benson, L.; Gold, R. Eosinophilic myocarditis temporally associated with conjugate meningococcal C and hepatitis B vaccines in children. Pediatr. Infect. Dis. J. 2008, 27, 831–835. [Google Scholar] [CrossRef]
  23. Engler, R.J.; Nelson, M.R.; Collins, L.C., Jr.; Spooner, C.; Hemann, B.A.; Gibbs, B.T.; Atwood, J.E.; Howard, R.S.; Chang, A.S.; Cruser, D.L.; et al. A prospective study of the incidence of myocarditis/pericarditis and new onset cardiac symptoms following smallpox and influenza vaccination. PLoS ONE 2015, 10, e0118283. [Google Scholar] [CrossRef] [Green Version]
  24. Staff, T. Israel Said Probing Link between P3zer Shot and Heart Problem in Men under 30. 2021. Available online: https://www.timesofisrael.com/israel-said-probing-link-between-pfizer-shot-and-heart-problem-in-men-under-30/ (accessed on 17 May 2021).
  25. Prevention CDC COVID-19 VaST Work Group Report. Available online: https://www.cdc.gov/vaccines/acip/work-groups-vast/report-2021-05-17.html (accessed on 17 May 2021).
  26. Boehmer, T.K.; Kompaniyets, L.; Lavery, A.M.; Hsu, J.; Ko, J.Y.; Yusuf, H.; Romano, S.D.; Gundlapalli, A.V.; Oster, M.E.; Harris, A.M. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data—United States, March 2020-January 2021. MMWR Morb. Mortal. Wkly. Rep. 2021, 70, 1228–1232. [Google Scholar] [CrossRef] [PubMed]
  27. Mele, D.; Flamigni, F.; Rapezzi, C.; Ferrari, R. Myocarditis in COVID-19 patients: Current problems. Intern. Emerg. Med. 2021, 16, 1123–1129. [Google Scholar] [CrossRef]
  28. Ferreira, V.M.; Schulz-Menger, J.; Holmvang, G.; Kramer, C.M.; Carbone, I.; Sechtem, U.; Kindermann, I.; Gutberlet, M.; Cooper, L.T.; Liu, P.; et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J. Am. Coll. Cardiol. 2018, 72, 3158–3176. [Google Scholar] [CrossRef]
  29. Pan, J.A.; Lee, Y.J.; Salerno, M. Diagnostic Performance of Extracellular Volume, Native T1, and T2 Mapping Versus Lake Louise Criteria by Cardiac Magnetic Resonance for Detection of Acute Myocarditis: A Meta-Analysis. Circ. Cardiovasc. Imaging 2018, 11, e007598. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  30. Luetkens, J.A.; Faron, A.; Isaak, A.; Dabir, D.; Kuetting, D.; Feisst, A.; Schmeel, F.; Sprinkart, A.M.; Thomas, D. Comparison of Original and 2018 Lake Louise Criteria for Diagnosis of Acute Myocarditis: Results of a Validation Cohort. Radiol. Cardiothorac. Imaging 2019, 1, e190010. [Google Scholar] [CrossRef]
  31. Friedrich, M.G.; Marcotte, F. Cardiac magnetic resonance assessment of myocarditis. Circ. Cardiovasc. Imaging 2013, 6, 833–839. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  32. Hsiao, J.F.; Koshino, Y.; Bonnichsen, C.R.; Yu, Y.; Miller, F.A., Jr.; Pellikka, P.A.; Cooper, L.T., Jr.; Hector, R.; Villarraga, H.R. Speckle tracking echocardiography in acute myocarditis. Int. J. Cardiovasc. Imaging 2013, 29, 275–284. [Google Scholar] [CrossRef]
  33. Albert, E.; Aurigemma, G.; Saucedo, J.; Gerson, D.S. Myocarditis following COVID-19 vaccination. Radiol. Case Rep. 2021, 16, 2142–2145. [Google Scholar] [CrossRef] [PubMed]
  34. Rosner, C.M.; Genovese, L.; Tehrani, B.N.; Atkins, M.; Bakhshi, H.; Chaudhri, S.; Damluji, A.A.; de Lemos, J.A.; Desai, S.S.; Emaminia, A.; et al. Myocarditis Temporally Associated with COVID-19 Vaccination. Circulation 2021, 144, 502–505. [Google Scholar] [CrossRef] [PubMed]
  35. Keshavarz, P.; Yazdanpanah, F.; Azhdari, S.; Kavandi, H.; Nikeghbal, P.; Bazyar, A.; Rafiee, F.; Nejati, S.F.; Sadabad, F.E.; Rezaei, N. Coronavirus disease 2019 (COVID-19): A systematic review of 133 Children that presented with Kawasaki-like multisystem inflammatory syndrome. J. Med. Virol. 2021, 93, 5458–5473. [Google Scholar] [CrossRef] [PubMed]
  36. Jhaveri, R.; Adler-Shohet, F.C.; Blyth, C.C.; Chiotos, K.; Gerber, J.S.; Green, M.; Kociolek, L.; Martin-Blais, R.; Palazzi, D.; Shane, A.L.; et al. Weighing the Risks of Perimyocarditis with the Benefits of SARS-CoV-2 mRNA Vaccination in Adolescents. J. Pediatr. Infect. Dis. Soc. 2021, 10, 937–939. [Google Scholar] [CrossRef] [PubMed]
  37. D’Angelo, T.; Cattafi, A.; Carerj, M.L.; Booz, C.; Ascenti, G.; Cicero, G.; Blandino, A.; Mazziotti, S. Myocarditis After SARS-CoV-2 Vaccination: A Vaccine-Induced Reaction? Can. J. Cardiol. 2021, 37, 1665–1667. [Google Scholar] [CrossRef]
  38. Deb, A.; Abdelmalek, J.; Iwuji, K.; Nugent, K. Acute Myocardial Injury Following COVID-19 Vaccination: A Case Report and Review of Current Evidence from Vaccine Adverse Events Reporting System Database. J. Prim. Care Community Health 2021, 12, 21501327211029230. [Google Scholar] [CrossRef]
  39. Bautista García, J.; Peña Ortega, P.; Bonilla Fernández, J.A.; Cárdenes León, A.; Ramírez Burgos, L.; Caballero Dorta, E. Acute myocarditis after administration of the BNT162b2 vaccine against COVID. Rev. Esp. Cardiol. 2021, 74, 812–814. [Google Scholar] [CrossRef] [PubMed]
  40. Shaw, K.E.; Cavalcante, J.L.; Han, B.K.; Gössl, M. Possible Association Between COVID-19 Vaccine and Myocarditis: Clinical and CMR Findings. Cardiovasc. Imaging 2021, 14, 1856–1861. [Google Scholar] [CrossRef]
  41. Watkins, K.; Griffin, G.; Septaric, K.; Simon, E.L. Myocarditis after BNT162b2 vaccination in a healthy male. Am. J. Emerg. Med. 2021, 50, e1–e2. [Google Scholar] [CrossRef] [PubMed]
  42. Singh, B.; Kaur, P.; Cedeno, L.; Brahimi, T.; Patel, P.; Virk, H.; Shamoon, F.; Bikkina, M. COVID-19 mRNA Vaccine and Myocarditis. Eur. J. Case Rep. Intern. Med. 2021, 8, 002681. [Google Scholar] [CrossRef] [PubMed]
  43. Muthukumar, A.; Narasimhan, M.; Li, Q.Z.; Mahimainathan, L.; Hitto, I.; Fuda, F.; Batra, K.; Jiang, X.; Zhu, C.; Schoggins, J.; et al. In-Depth Evaluation of a Case of Presumed Myocarditis after the Second Dose of COVID-19 mRNA Vaccine. Circulation 2021, 144, 487–498. [Google Scholar] [CrossRef] [PubMed]
  44. Minocha, P.K.; Better, D.; Singh, R.K.; Hoque, T. Recurrence of Acute Myocarditis Temporally Associated with Receipt of the mRNA Coronavirus Disease 2019 (COVID-19) Vaccine in a Male Adolescent. J. Pediatr. 2021, 238, 321–323. [Google Scholar] [CrossRef] [PubMed]
  45. Dickey, J.B.; Albert, E.; Badr, M.; Laraja, K.M.; Sena, L.M.; Gerson, D.S.; Saucedo, J.E.; Qureshi, W.; Aurigemma, G.P. A Series of Patients with Myocarditis following SARS-CoV-2 Vaccination with mRNA-1279 and Bnt162b. Cardiovasc. Imaging 2021, 14, 1862–1863. [Google Scholar] [CrossRef]
  46. Kim, H.W.; Jenista, E.R.; Wendell, D.C.; Azevedo, C.F.; Campbell, M.J.; Darty, S.N.; Parker, M.A.; Kim, R.J. Patients with Acute Myocarditis following mRNA COVID-19 Vaccination. JAMA Cardiol. 2021, 6, 1196–1201. [Google Scholar] [CrossRef] [PubMed]
  47. Larson, K.F.; Ammirati, E.; Adler, E.D.; Cooper, L.T.; Hong, K.N.; Saponara, G.; Couri, D.; Cereda, A.; Procopio, A.; Cavalotti, C.; et al. Myocarditis After BNT162b2 and mRNA-1273 Vaccination. Circulation 2021, 144, 506–508. [Google Scholar] [CrossRef] [PubMed]
  48. Vidula, M.K.; Ambrose, M.; Glassberg, H.; Chokshi, N.; Chen, T.; Ferrari, V.A.; Han, Y. Myocarditis and Other Cardiovascular Complications of the mRNA-Based COVID-19 Vaccines. Cureus 2021, 13, e15576. [Google Scholar] [CrossRef] [PubMed]
  49. Marshall, M.; Ferguson, I.D.; Lewis, P.; Jaggi, P.; Gagliardo, C.; Collins, J.S.; Shaughnessy, R.; Caron, R.; Fuss, C.; Corbin, K.J.E.; et al. Symptomatic Acute Myocarditis in 7 Adolescents after Pfizer-BioNTech COVID-19 Vaccination. Pediatrics 2021, 148. [Google Scholar] [CrossRef]
  50. Montgomery, J.; Ryan, M.; Engler, R.; Hoffman, D.; McClenathan, B.; Collins, L.; Loran, D.; Hrncir, D.; Herring, K.; Platzer, M.; et al. Myocarditis Following Immunization with mRNA COVID-19 Vaccines in Members of the US Military. JAMA Cardiol. 2021, 6, 1202–1206. [Google Scholar] [CrossRef] [PubMed]
  51. Abu Mouch, S.; Roguin, A.; Hellou, E.; Ishai, A.; Shoshan, U.; Mahamidm, L.; Zoabi, M.; Aisman, M.; Goldschmid, N.; Berar Yanay, N. Myocarditis following COVID-19 mRNA vaccination. Vaccine 2021, 39, 3790–3793. [Google Scholar] [CrossRef]
  52. Nevet, A. Acute myocarditis associated with anti-COVID-19 vaccination. Clin. Exp. Vaccine Res. 2021, 10, 196–197. [Google Scholar] [CrossRef]
  53. Schauer, J.; Buddhe, S.; Colyer, J.; Sagiv, E.; Law, Y.; Mallenahalli Chikkabyrappa, S.; Portman, M.A. Myopericarditis After the Pfizer Messenger Ribonucleic Acid Coronavirus Disease Vaccine in Adolescents. J. Pediatr. 2021, 238, 317–320. [Google Scholar] [CrossRef]
  54. Park, J.; Brekke, D.R.; Bratincsak, A. Self-limited myocarditis presenting with chest pain and ST segment elevation in adolescents after vaccination with the BNT162b2 mRNA vaccine. Cardiol. Young 2022, 32, 146–149. [Google Scholar] [CrossRef] [PubMed]
  55. Cereda, A.; Conca, C.; Barbieri, L.; Ferrante, G.; Tumminello, G.; Lucreziotti, S.; Guazzi, M.; Mafrici, A. Acute myocarditis after the second dose of SARS-CoV-2 vaccine: Serendipity or atypical causal relationship? Anatol. J. Cardiol. 2021, 25, 522–523. [Google Scholar] [CrossRef] [PubMed]
  56. Williams, C.B.; Choi, J.-i.; Hosseini, F.; Roberts, J.; Ramanathan, K.; Ong, K. Acute Myocarditis following mRNA-1273 SARS-CoV-2 Vaccination. CJC Open. 2021, 3, 1410–1412. [Google Scholar] [CrossRef] [PubMed]
  57. Starekova, J.; Bluemke, D.A.; Bradham, W.S.; Grist, T.M.; Schiebler, M.L.; Reeder, S.B. Myocarditis Associated with mRNA COVID-19 Vaccination. Radiology 2021, 301, e409–e411. [Google Scholar] [CrossRef]
  58. Di Tano, G.M.L.; Calvaruso, E.V.; Danzi, G.B. Recurrent Myocarditis after the First Dose of SARS-CoV-2 mRNA- 1273 Vaccine. Ann. Clin. Case Rep. 2021, 6, 2018. [Google Scholar]
  59. Khogali, F.; Abdelrahman, R. Unusual Presentation of Acute Perimyocarditis following SARS-COV-2 mRNA-1237 Moderna Vaccination. Cureus 2021, 13, e16590. [Google Scholar] [CrossRef] [PubMed]
  60. Tano, E.; San Martin, S.; Girgis, S.; Martinez-Fernandez, Y.; Sanchez Vegas, C. Perimyocarditis in Adolescents after Pfizer-BioNTech COVID-19 Vaccine. J. Pediatr. Infect. Dis. Soc. 2021, 10, 962–966. [Google Scholar] [CrossRef] [PubMed]
  61. Verma, A.K.; Lavine, K.J.; Lin, C.Y. Myocarditis after Covid-19 mRNA Vaccination. N. Engl. J. Med. 2021, 385, 1332–1334. [Google Scholar] [CrossRef]
  62. Levin, D.; Shimon, G.; Fadlon-Derai, M.; Gershovitz, L.; Shovali, A.; Sebbag, A.; Bader, S.; Fink, N.; Gordon, B. Myocarditis following COVID-19 vaccination—A case series. Vaccine 2021, 39, 6195–6200. [Google Scholar] [CrossRef]
  63. Shumkova, M.; Vassilev, D.; Karamfiloff, K.; Ivanova, R.; Stoyanova, K.; Yaneva-Sirakova, T.; Gil, R.J. Acute myocarditis associated with the Pfizer/BioNTech vaccine. Kardiol. Pol. 2021, 79, 1282–1283. [Google Scholar] [CrossRef] [PubMed]
  64. Cimaglia, P.; Tolomeo, P.; Rapezzi, C. Acute myocarditis after SARS-CoV-2 vaccination in a 24-year-old man. Rev. Port. Cardiol. 2022, 41, 71–72. [Google Scholar] [CrossRef]
  65. Dionne, A.; Sperotto, F.; Chamberlain, S.; Baker, A.L.; Powell, A.J.; Prakash, A.; Castellanos, D.A.; Saleeb, S.F.; de Ferranti, S.D.; Newburger, J.W.; et al. Association of Myocarditis with BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children. JAMA Cardiol. 2021, 6, 1446–1450. [Google Scholar] [CrossRef] [PubMed]
  66. Ehrlich, P.; Klingel, K.; Ohlmann-Knafo, S.; Hüttinger, S.; Sood, N.; Pickuth, D.; Kindermann, M. Biopsy-proven lymphocytic myocarditis following first mRNA COVID-19 vaccination in a 40-year-old male: Case report. Clin. Res. Cardiol. 2021, 110, 1855–1859. [Google Scholar] [CrossRef] [PubMed]
  67. Gautam, N.; Saluja, P.; Fudim, M.; Jambhekar, K.; Pandey, T.; Al’Aref, S. A Late Presentation of COVID-19 Vaccine-Induced Myocarditis. Cureus 2021, 13, e17890. [Google Scholar] [CrossRef] [PubMed]
  68. Kim, I.C.; Kim, H.; Lee, H.J.; Kim, J.Y.; Kim, J.Y. Cardiac Imaging of Acute Myocarditis following COVID-19 mRNA Vaccination. J. Korean Med. Sci. 2021, 36, e229. [Google Scholar] [CrossRef] [PubMed]
  69. Jain, S.S.; Steele, J.M.; Fonseca, B.; Huang, S.; Shah, S.; Maskatia, S.A.; Buddhe, S.; Misra, N.; Ramachandran, P.; Gaur, L.; et al. COVID-19 Vaccination-Associated Myocarditis in Adolescents. Pediatrics 2021, 148. [Google Scholar] [CrossRef] [PubMed]
  70. King, W.W.; Petersen, M.R.; Matar, R.M.; Budweg, J.B.; Cuervo Pardo, L.; Petersen, J.W. Myocarditis following mRNA vaccination against SARS-CoV-2, a case series. Am. Heart J. Plus Cardiol. Res. Pract. 2021, 8, 100042. [Google Scholar] [CrossRef] [PubMed]
  71. Matta, A.; Kallamadi, R.; Matta, D.; Bande, D. Post-mRNA COVID-19 Vaccination Myocarditis. Eur. J. Case Rep. Intern. Med. 2021, 8, 002769. [Google Scholar] [CrossRef] [PubMed]
  72. Patel, Y.R.; Louis, D.W.; Atalay, M.; Agarwal, S.; Shah, N.R. Cardiovascular magnetic resonance findings in young adult patients with acute myocarditis following mRNA COVID-19 vaccination: A case series. J. Cardiovasc. Magn. Reson. 2021, 23, 101. [Google Scholar] [CrossRef] [PubMed]
  73. Patrignani, A.; Schicchi, N.; Calcagnoli, F.; Falchetti, E.; Ciampani, N.; Argalia, G.; Mariani, A. Acute myocarditis following Comirnaty vaccination in a healthy man with previous SARS-CoV-2 infection. Radiol. Case Rep. 2021, 16, 3321–3325. [Google Scholar] [CrossRef] [PubMed]
  74. Sulemankhil, I.; Abdelrahman, M.; Negi, S.I. Temporal association between the COVID-19 Ad26.COV2.S vaccine and acute myocarditis: A case report and literature review. Cardiovasc. Revasc. Med. 2021, 38, 117–123. [Google Scholar] [CrossRef] [PubMed]
  75. Tailor, P.D.; Feighery, A.M.; El-Sabawi, B.; Prasad, A. Case report: Acute myocarditis following the second dose of mRNA-1273 SARS-CoV-2 vaccine. Eur. Heart J. Case Rep. 2021, 5, ytab319. [Google Scholar] [CrossRef] [PubMed]
  76. Ujueta, F.; Azimi, R.; Lozier, M.R.; Poppiti, R.; Ciment, A. Lymphohistocytic myocarditis after Ad26.COV2.S viral vector COVID-19 vaccination. Int. J. Cardiol. Heart Vasc. 2021, 36, 100869. [Google Scholar] [CrossRef] [PubMed]
  77. Hung, Y.P.; Sun, K.S. A case of myopericarditis with pleuritis following AstraZeneca Covid-19 vaccination. QJM Int. J. Med. 2022, 114, 879–881. [Google Scholar] [CrossRef] [PubMed]
  78. Kaneta, K.; Yokoi, K.; Jojima, K.; Kotooka, N.; Node, K. Young Male with Myocarditis following mRNA-1273 Vaccination Against Coronavirus Disease-2019 (COVID-19). Circ. J. 2022, 86, 721. [Google Scholar] [CrossRef] [PubMed]
  79. Kaul, R.; Sreenivasan, J.; Goel, A.; Malik, A.; Bandyopadhyay, D.; Jin, C.; Sharma, M.; Levine, A.; Pan, S.; Fuisz, A.; et al. Myocarditis following COVID-19 vaccination. Int. J. Cardiol. Heart Vasc. 2021, 36, 100872. [Google Scholar] [CrossRef] [PubMed]
  80. Kim, D.; Choi, J.H.; Jang, J.Y.; So, O.; Cho, E.; Choi, H.; Hong, K.S.; Park, K.T. A Case Report for Myopericarditis after BNT162b2 COVID-19 mRNA Vaccination in a Korean Young Male. J. Korean Med. Sci. 2021, 36, e277. [Google Scholar] [CrossRef] [PubMed]
  81. Koizumi, T.; Awaya, T.; Yoshioka, K.; Kitano, S.; Hayama, H.; Amemiya, K.; Enomoto, Y.; Yazaki, Y.; Moroi, M.; Nakamura, M. Myocarditis after COVID-19 mRNA vaccines. QJM Int. J. Med. 2021, 114, 741–743. [Google Scholar] [CrossRef] [PubMed]
  82. Maki, H.; Aikawa, T.; Ibe, T.; Oyama-Manabe, N.; Fujita, H. Biventricular systolic dysfunction in acute myocarditis after SARS-CoV-2 mRNA-1273 vaccination. Eur. Heart J. Cardiovasc. Imaging 2022, 23, e87. [Google Scholar] [CrossRef]
  83. Miqdad, M.A.; Nasser, H.; Alshehri, A.; Mourad, A.R. Acute Myocarditis following the Administration of the Second BNT162b2 COVID-19 Vaccine Dose. Cureus 2021, 13, e18880. [Google Scholar] [CrossRef] [PubMed]
  84. Nguyen, T.D.; Mall, G.; Westphal, J.G.; Weingärtner, O.; Möbius-Winkler, S.; Schulze, P.C. Acute myocarditis after COVID-19 vaccination with mRNA-1273 in a patient with former SARS-CoV-2 infection. Esc. Heart Fail. 2021, 8, 4710–4714. [Google Scholar] [CrossRef] [PubMed]
  85. Onderko, L.; Starobin, B.; Riviere, A.E.; Hohl, P.K.; Phillips, C.T.; Morgan, R.B.; Welsh, A.; Francis, S.A.; Afari, M.E. Myocarditis in the Setting of Recent COVID-19 Vaccination. Case Rep. Cardiol. 2021, 2021, 6806500. [Google Scholar] [CrossRef] [PubMed]
  86. Pareek, M.; Asnes, J.; Baldassarre, L.; Casale, L.; Desai, N.; Elder, R.; Faherty, E.; Ferguson, I.; Fishman, R.; Ghazizadeh, Z.; et al. Myopericarditis after Covid-19 Vaccination—A Case Series. SSRN 2021. Available online: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3874571 (accessed on 6 May 2022).
  87. Perez, Y.; Levy, E.R.; Joshi, A.Y.; Virk, A.; Rodriguez-Porcel, M.; Johnson, M.; Roellinger, D.; Vanichkachorn, G.; Huskins, W.C.; Swift, M.D. Myocarditis following COVID-19 mRNA Vaccine: A Case Series and Incidence Rate Determination. Clin. Infect. Dis. 2021. [Google Scholar] [CrossRef]
  88. Sakaguchi, S.; Fujimoto, N.; Ichikawa, K.; Izumi, D.; Katsuta, K.; Takafuji, M.; Imanaka-Yoshida, K.; Dohi, K. Myopericarditis after COVID-19 mRNA Vaccination. Circ. J. 2022, 86, 472. [Google Scholar] [CrossRef] [PubMed]
  89. Schmitt, P.; Demoulin, R.; Poyet, R.; Capilla, E.; Rohel, G.; Pons, F.; Jégo, C.; Sidibe, S.; Druelle, A.; Brocq, F.X.; et al. Acute Myocarditis after COVID-19 vaccination: A case report. Rev. Med. Interne 2021, 42, 797–800. [Google Scholar] [CrossRef] [PubMed]
  90. Sivakumaran, P.; Sunny, J.; Tsagkridi, A.; Khanji, M.Y. Myopericarditis following SARS-CoV-2 mRNA vaccine: The role of cardiac biomarkers and multimodality imaging. Eur. Heart J. Cardiovasc. Imaging 2022, 23, e134. [Google Scholar] [CrossRef] [PubMed]
  91. Viskin, D.; Topilsky, Y.; Aviram, G.; Mann, T.; Sadon, S.; Hadad, Y.; Flint, N.; Shmilovich, H.; Banai, S.; Havakuk, O. Myocarditis Associated with COVID-19 Vaccination: Echocardiography, Cardiac Tomography, and Magnetic Resonance Imaging Findings. Circ. Cardiovasc. Imaging 2021, 14, e013236. [Google Scholar] [CrossRef] [PubMed]
  92. Vollmann, D.; Eiffert, H.; Schuster, A. Acute Perimyocarditis following First Dose of mRNA Vaccine against COVID. Dtsch. Ärzteblatt Int. 2021, 118, 546. [Google Scholar] [CrossRef]
  93. Wilson, H.; Norris, M.D.; Frosch, O.; Agarwal, P.P. Late Gadolinium Enhancement after COVID-19 Vaccination. Radiol. Cardiothorac. Imaging 2021, 3, e210199. [Google Scholar] [CrossRef]
  94. Hasnie, A.A.; Hasnie, U.A.; Patel, N.; Aziz, M.U.; Xie, M.; Lloyd, S.G.; Prabhu, S.D. Perimyocarditis following first dose of the mRNA-1273 SARS-CoV-2 (Moderna) vaccine in a healthy young male: A case report. BMC Cardiovasc. Disord. 2021, 21, 375. [Google Scholar] [CrossRef] [PubMed]
  95. Habedank, D.; Lagast, A.; Novoa-Usme, M.; Atmowihardjo, I. A case of myocarditis in a 60-year-old man 48 h after mRNA vaccination against SARS. Covclin. Res. Cardiol. 2022, 111, 230–232. [Google Scholar] [CrossRef]
  96. Angel Goenawan, F.K.; Kenneth, S.; Seema, D. Recurrent mRNA (BNT162b2) Covid-19 Vaccine-Associated Pericarditis in an Elderly Man with Multiple Comorbidities. Am. J. Med. Case Rep. 2021, 9, 709–713. [Google Scholar] [CrossRef]
  97. Fleming-Nouri, A.; Haimovich, A.D.; Yang, D.; Schulz, W.L.; Coppi, A.; Taylor, R.A. Myopericarditis in young adults presenting to the emergency department after receiving a second COVID-19 mRNA vaccine. Acad. Emerg. Med. 2021, 28, 802. [Google Scholar] [CrossRef] [PubMed]
  98. Das, B.B.; Kohli, U.; Ramachandran, P.; Nguyen, H.H.; Greil, G.; Hussain, T.; Tandon, A.; Kane, C.; Avula, S.; Duru, C.; et al. Myopericarditis after messenger RNA Coronavirus Disease 2019 Vaccination in Adolescents 12 to 18 Years of Age. J. Pediatr. 2021, 238, 26–32.e1. [Google Scholar] [CrossRef]
  99. Chen, D.H.; Arefin, A.R.; Joshi, A.; Khanji, M.Y. Myopericarditis in a teenager following first mRNA COVID vaccine dose: The role of multi-parametric cardiovascular magnetic resonance. Eur. Heart J. Case Rep. 2021, 5, ytab371. [Google Scholar] [CrossRef] [PubMed]
  100. Chelala, L.; Jeudy, J.; Hossain, R.; Rosenthal, G.; Pietris, N.; White, C.S. Cardiac MRI Findings of Myocarditis after COVID-19 mRNA Vaccination in Adolescents. Am. J. Roentgenol. 2022, 218, 651–657. [Google Scholar] [CrossRef] [PubMed]
  101. Boursier, C.; Chevalier, E.; Filippetti, L.; Imbert, L.; Roch, V.; Huttin, O.; Claudin, M.; Marie, P.Y. 68Ga-DOTATOC digital-PET imaging of inflammatory cell infiltrates in myocarditis following COVID-19 vaccination. Eur. J. Nucl. Med. Mol. Imaging 2022, 49, 1433–1434. [Google Scholar] [CrossRef]
  102. Badshah, M.; Shriver, J.; Rynders, B.; Sjovold, A.; Shaukat, M.H.S.; Rajpurohit, N. MODERNA mRNA-1273 vaccine-associated myopericarditis in a patient with a subclinical autoimmune predisposition. J. Cardio. Cases 2021, 24, 227–229. [Google Scholar] [CrossRef]
  103. Azir, M.; Inman, B.; Webb, J.; Tannenbaum, L. STEMI Mimic: Focal Myocarditis in an Adolescent Patient after mRNA COVID-19 Vaccine. J. Emerg. Med. 2021, 61, e129–e132. [Google Scholar] [CrossRef]
  104. Ambati, S.; Colon, M.; Mihic, M.; Sanchez, J.; Bakar, A. Acute Myopericarditis after COVID-19 Vaccine in Teenagers. Case Rep. Cardiol. 2021, 2021, 8268755. [Google Scholar] [CrossRef]
  105. Sokolska, J.M.; Kurcz, J.; Kosmala, W. Every rose has its thorns—Acute myocarditis following COVID-19 vaccination. Kardio. Pol. 2021, 79, 1153–1154. [Google Scholar] [CrossRef] [PubMed]
  106. Lazaros, G.; Anastassopoulou, C.; Hatziantoniou, S.; Kalos, T.; Soulaidopoulos, S.; Lazarou, E.; Vlachopoulos, C.; Vassilopoulos, D.; Tsakris, A.; Tsioufis, C. A case series of acute pericarditis following COVID-19 vaccination in the context of recent reports from Europe and the United States. Vaccine 2021, 39, 6585–6590. [Google Scholar] [CrossRef] [PubMed]
  107. Facetti, S.G.M.; Vecchi, A.L. Acute myocarditis in a young adult two days after Pfizer vaccine. G. Ital. Cardiol. 2021, 22, 891–893. [Google Scholar] [CrossRef]
  108. Meyer-Szary, J.; Bazgier, M.; Lubocka, P.; Dorniak, K.; Sabiniewicz, R. Cardiac magnetic resonance characteristics of acute myocarditis occurring after mRNA-based COVID-19 vaccines immunization. Cardiolj 2022, 29, 160–162. [Google Scholar] [CrossRef]
  109. Aikawa, T.; Ogino, J.; Kita, Y.; Funayama, N. Myocardial microthrombi after COVID-19 mRNA vaccination. Eur. Heartj. 2021, 42, 4501. [Google Scholar] [CrossRef] [PubMed]
  110. Bricoli, S.; Cacciola, G.; Barocelli, F.; Guerra, C.; Zardini, M. 553 Myocarditis after COVID-19 vaccination—A case series. Eur. Heart J. Suppl. 2021, 23. [Google Scholar] [CrossRef]
  111. Chachar, T.S.; Yousuf, N.; Sulaibikh, L.; Abdulqader, F.; Alqahtani, M. First Report of Acute Myocarditis Post-Pfizer-BioNTech COVID-19 Vaccination in the Kingdom of Bahrain. Cureus 2021, 13, e20313. [Google Scholar] [CrossRef] [PubMed]
  112. Eggebrecht, H.; Breitbart, P.; Koch, A.; Nowak, B.; Walther, C.; Voigtländer, T.; Liebetrau, C.; Metha, R.H.; Schmermund, A. Trends in ambulatory cardiology consultations for suspected myocarditis after COVID-19 vaccination. Clin. Res. Cardiol. 2022, 111, 237–239. [Google Scholar] [CrossRef]
  113. Istampoulouoglou, I.; Dimitriou, G.; Späni, S.; Christ, A.; Zimmermanns, B.; Koechlin, S.; Stoeckmann, O.; Winterhalder, C.; Marono, D.; Toma, V.; et al. Myocarditis and pericarditis in association with COVID-19 mRNA-vaccination: Cases from a regional pharmacovigilance centre. Glob. Cardiol. Sci. Pract. 2021, 2021, e202118. [Google Scholar] [CrossRef] [PubMed]
  114. Lim, Y.; Kim, M.C.; Kim, K.H.; Jeong, I.S.; Cho, Y.S.; Choi, Y.D.; Lee, J.E. Case Report: Acute Fulminant Myocarditis and Cardiogenic Shock after Messenger RNA Coronavirus Disease 2019 Vaccination Requiring Extracorporeal Cardiopulmonary Resuscitation. Front. Cardiovasc. Med. 2021, 8. [Google Scholar] [CrossRef]
  115. McCullough, J.; McCullough, J.P.; Korlipara, G.; Kaell, A. Myocarditis Post Moderna Vaccination: Review of Criteria for Diagnosis. Cureus 2021, 13, e19633. [Google Scholar] [CrossRef] [PubMed]
  116. Murakami, Y.; Shinohara, M.; Oka, Y.; Wada, R.; Noike, R.; Ohara, H.; Fujino, T.; Ikeda, T. Myocarditis following a COVID-19 Messenger RNA Vaccination: A Japanese Case Series. Intern. Med. 2022, 61, 501–505. [Google Scholar] [CrossRef] [PubMed]
  117. Nagasaka, T.; Koitabashi, N.; Ishibashi, Y.; Aihara, K.; Takama, N.; Ohyama, Y.; Yokoyama, T.; Kaneko, Y. Acute Myocarditis Associated with COVID-19 Vaccination: A Case Report. J. Cardiol. Cases 2021. [Google Scholar] [CrossRef] [PubMed]
  118. Parmar, K.; Mekraksakit, P.; Del Rio-Pertuz, G.; Sethi, P.; Motes, A.; Hughes, M.; Wischmeyer, J.; Carbajal, L.; Sosa, E.A. Myocarditis following COVID-19 mRNA vaccination. Bayl. Univ. Med. Cent. Proc. 2022, 35, 209–213. [Google Scholar] [CrossRef] [PubMed]
  119. Singh, R.; Chakrabarti, S.S.; Gambhir, I.S.; Verma, A.; Kumar, I.; Ghosh, S.; Tiwari, A.; Chandan, G.; Chakrabarti, S.; Kaur, U. Acute Cardiac Events after ChAdOx1 nCoV-19 Corona Virus Vaccine: Report of Three Cases. Am. J. Ther. 2022. [Google Scholar] [CrossRef] [PubMed]
  120. Takeda, M.; Ishio, N.; Shoji, T.; Mori, N.; Matsumoto, M.; Shikama, N. Eosinophilic Myocarditis following Coronavirus Disease 2019 (COVID-19) Vaccination. Circ. J. 2021. [Google Scholar] [CrossRef] [PubMed]
  121. Tinoco, M.; Leite, S.; Faria, B.; Cardoso, S.; Von Hafe, P.; Dias, G.; Cardoso, F.; Pereira, T.; Machado, I.; Lourenço, A. Perimyocarditis following COVID-19 Vaccination. Clin. Med. Insights Cardiol. 2021, 15, 11795468211056634. [Google Scholar] [CrossRef] [PubMed]
  122. Ashutosh, T.; Sankha Shubhra, C.; Prasan Kumar, P.; Gaurav, K.; Upinder, K. Hyper-eosinophilic syndrome with myocarditis after inactivated SARS-CoV-2 vaccination: A case study. Res. Sq. 2022. [Google Scholar] [CrossRef]
  123. Di Dedda, E.A.; Barison, A.; Aquaro, G.D.; Ismail, T.F.; Hua, A.; Mantini, C.; Ricci, F.; Pontone, G.; Volpe, A.; Secchi, F.; et al. Cardiac magnetic resonance imaging of myocarditis and pericarditis following COVID-19 vaccination: A multicenter collection of 27 cases. Eur. Radiol. 2022, 1–9. [Google Scholar] [CrossRef] [PubMed]
  124. Fronza, M.; Thavendiranathan, P.; Chan, V.; Karur, G.R.; Udell, J.A.; Wald, R.M.; Hong, R.; Hanneman, K. Myocardial Injury Pattern at MRI in COVID-19 Vaccine-associated Myocarditis. Radiology 2022, 212559. [Google Scholar] [CrossRef] [PubMed]
  125. Bews, H.; Bryson, A.; Bortoluzzi, T.; Tam, J.W.; Jassal, D.S. COVID-19 vaccination induced myopericarditis: An imager’s perspective. CJC Open 2022. [Google Scholar] [CrossRef] [PubMed]
  126. Manfredi, R.; Bianco, F.; Bucciarelli, V.; Ciliberti, G.; Guerra, F.; Schicchi, N.; Tavio, M.; Berton, E.; Surace, F.C.; Colaneri, M.; et al. Clinical Profiles and CMR Findings of Young Adults and Pediatrics with Acute Myocarditis Following mRNA COVID-19 Vaccination: A Case Series. Vaccines 2022, 10, 169. [Google Scholar] [CrossRef] [PubMed]
  127. Sharff, K.A.; Dancoes, D.M.; Longueil, J.L.; Lewis, P.F.; Johnson, E.S. Myopericarditis After COVID-19 Booster Dose Vaccination. Am. J. Cardiol. 2022, 172, 165–166. [Google Scholar] [CrossRef] [PubMed]
  128. Nunn, S.; Kersten, J.; Tadic, M.; Wolf, A.; Gonska, B.; Hüll, E.; Dietenberger, H.; Rottbauer, W.; Buckert, D. Case Report: Myocarditis After COVID-19 Vaccination—Case Series and Literature Review. Front. Med. 2022, 9, 836620. [Google Scholar] [CrossRef] [PubMed]
  129. Bengel, C.P.; Kacapor, R. A report of two cases of myocarditis following mRNA coronavirus disease 2019 vaccination. Eur. Heart J. Case Rep. 2022, 6, ytac004. [Google Scholar] [CrossRef] [PubMed]
  130. Ohnishi, M.; Tanaka, Y.; Nishida, S.; Sugimoto, T. Case report of acute myocarditis after administration of coronavirus disease 2019 vaccine in Japan. Eur. Heart J. Case Rep. 2022, 6, ytab534. [Google Scholar] [CrossRef] [PubMed]
  131. Owuor, H.; Gikonyo, A.; Ponoth, P.; Gikonyo, D. Covid Vaccine Induced Myocarditis: A Bolt from the Blue: A Case Report. J. Cardiovasc. Med. Surg. 2022, 7, 51–55. [Google Scholar] [CrossRef]
  132. Sano, M.; Murai, R.; Kim, K.; Furukawa, Y. Cardiac magnetic resonance findings in acute myocarditis after mRNA COVID-19 vaccination. J. Cardiol. Cases 2022. [Google Scholar] [CrossRef]
  133. Wong, J.; Sharma, S.; Yao, J.V.; Aggarwal, A.; Grigg, L. COVID-19 mRNA vaccine (Comirnaty)-induced myocarditis. Med. J. Aust. 2022, 216, 122–123. [Google Scholar] [CrossRef]
  134. Wu, B.; Mittal, N.; Adler, E.D.; Hong, K.N. Acute myocarditis after receiving first dose of BNT162b2 mRNA vaccine. J. Cardiol. Cases 2022. [Google Scholar] [CrossRef] [PubMed]
  135. Yen, K.C.; Ho, C.T.; Chin, S.C.; Su, H.C.; Lee, K.T.; Chu, P.H. Self-Limited Myocarditis after the First Dose of Coronavirus Disease 2019 Messenger RNA-1273 Vaccine in a Healthy Male. Acta Cardiol. Sin. 2022, 38, 210–213. [Google Scholar] [CrossRef] [PubMed]
  136. Mohammadi, A.; Rezaiye, M.; Goharrizi, M.A.S.B. Acute Myocarditis following the Third Dose of SARS-CoV-2 Vaccine; A Case Report. Res. Sq. 2022. [Google Scholar] [CrossRef]
  137. Lee, C.H.; Kong, E.J. FDG PET/MRI of Acute Myocarditis after mRNA COVID-19 Vaccination. Clin. Nucl. Med. 2022. [Google Scholar] [CrossRef] [PubMed]
  138. Kyaw, H.; Shajahan, S.; Gulati, A.; Synn, S.; Khurana, S.; Nazar, N.; Shrestha, S.; Kerstein, J. COVID-19 mRNA Vaccine-Associated Myocarditis. Cureus 2022, 14, e21009. [Google Scholar] [CrossRef] [PubMed]
  139. Kounis, N.G.; Koniari, I.; Mplani, V.; Plotas, P.; Velissaris, D. Hypersensitivity myocarditis and the pathogenetic conundrum of COVID 19 Vaccine Related Myocarditis. Cardiology 2022. [Google Scholar] [CrossRef] [PubMed]
  140. Van Kerkhove, O.; Renders, F.; Leys, M. A case of myocarditis following ChAdOx1 nCov-19 vaccination. Acta Cardiol. 2022, 1–3. [Google Scholar] [CrossRef] [PubMed]
  141. Kawakami, T.; Yahagi, K.; Sekiguchi, M.; Ishizawa, T.; Nonaka, H.; Setoguchi, N.; Watanabe, Y.; Nakase, M.; Horiuchi, Y.; Asami, M.; et al. Acute Myocarditis in a Patient Following mRNA-1273 SARS-CoV-2 Vaccination. Intern. Med. 2022. [Google Scholar] [CrossRef]
  142. Gill, J.; Mallari, A.J.P.; Zahra, F. Transient Myopericarditis following Vaccination for COVID. J. Med. Cases 2022, 13, 80–84. [Google Scholar] [CrossRef]
  143. Agdamag, A.C.C.; Gonzalez, D.; Carlson, K.; Konety, S.; McDonald, W.C.; Martin, C.M. Fulminant myocarditis following coronavirus disease 2019 vaccination: A case report. Eur. Heart J.—Case Rep. 2022, 6, ytac007. [Google Scholar] [CrossRef]
  144. Fosch, X.; Serra, J.; Torres, P.L.; Preda, L.; González, R.; Mojer, F. Acute myocarditis after a third dose of the BNT162b2 COVID-19 vaccine. Rev. Esp. De Cardiol. 2022. [Google Scholar] [CrossRef]
Figure 1. Coronary angiography and cardiac MRI. (A) The right coronary artery only had a mild plaque (<30% luminal diameter) in the mid portion, whereas in (B) the left main stem, left anterior descending artery, and circumflex artery had no evidence of coronary plaques. (C) T2-weighted 3-chamber view on cardiac MRI, showing focal areas of edema involving the subepicardial-intramyocardial regions of the basal and apical segments of the inferolateral wall (arrows). (D) Late gadolinium enhancement confirmed the presence of non-ischemic myocardial lesions in the basal and apical segments of the inferolateral wall (arrows) consistent with acute myocarditis. Reprinted/adapted with permission from Ref. [13] 2021, Elsevier.
Figure 1. Coronary angiography and cardiac MRI. (A) The right coronary artery only had a mild plaque (<30% luminal diameter) in the mid portion, whereas in (B) the left main stem, left anterior descending artery, and circumflex artery had no evidence of coronary plaques. (C) T2-weighted 3-chamber view on cardiac MRI, showing focal areas of edema involving the subepicardial-intramyocardial regions of the basal and apical segments of the inferolateral wall (arrows). (D) Late gadolinium enhancement confirmed the presence of non-ischemic myocardial lesions in the basal and apical segments of the inferolateral wall (arrows) consistent with acute myocarditis. Reprinted/adapted with permission from Ref. [13] 2021, Elsevier.
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Figure 2. Cardiac MRI PSIR-LGE views show late gadolinium subepicardial enhancement in basal lateral segments in (a) four-chamber and (b) short-axis views. Reprinted/adapted with permission from Ref. [14]. 2021, Elsevier.
Figure 2. Cardiac MRI PSIR-LGE views show late gadolinium subepicardial enhancement in basal lateral segments in (a) four-chamber and (b) short-axis views. Reprinted/adapted with permission from Ref. [14]. 2021, Elsevier.
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Figure 3. Images of a 15-year-old boy with myocarditis after COVID-19 vaccination. One day after receiving his second vaccination dose, he developed fever, myalgia, and intermittent tachycardia. (A) T2-weighted short inversion time inversion recovery MRI scans at 1.5 T in short-axis view show focal high-signal intensities (arrow) at the basal lateral and inferior wall, indicating myocardial edema. (B) Late gadolinium enhancement image in short-axis view shows corresponding linear subepicardial enhancement (arrow), indicating inflammatory myocardial necrosis. (C) T1 mapping and (D) T2 mapping in the short-axis view show elevated T1 and T2 at the mid-ventricular lateral and inferolateral wall (arrow in (C,D)), indicating acute myocardial injury (focal T1, 1165 ms; focal T2, 70 ms; institution-specific cut-off values for acute myocarditis: T1 global ≥ 1000 ms, T2 global ≥ 55.9 ms). Reprinted/adapted with permission from Ref. [8], 2021, RSNA.
Figure 3. Images of a 15-year-old boy with myocarditis after COVID-19 vaccination. One day after receiving his second vaccination dose, he developed fever, myalgia, and intermittent tachycardia. (A) T2-weighted short inversion time inversion recovery MRI scans at 1.5 T in short-axis view show focal high-signal intensities (arrow) at the basal lateral and inferior wall, indicating myocardial edema. (B) Late gadolinium enhancement image in short-axis view shows corresponding linear subepicardial enhancement (arrow), indicating inflammatory myocardial necrosis. (C) T1 mapping and (D) T2 mapping in the short-axis view show elevated T1 and T2 at the mid-ventricular lateral and inferolateral wall (arrow in (C,D)), indicating acute myocardial injury (focal T1, 1165 ms; focal T2, 70 ms; institution-specific cut-off values for acute myocarditis: T1 global ≥ 1000 ms, T2 global ≥ 55.9 ms). Reprinted/adapted with permission from Ref. [8], 2021, RSNA.
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Figure 4. Magnetic Resonance Imaging of Case 2. Post-contrast magnitude inversion recovery (MAG-IR) (A) and phase-sensitive inversion recovery (PSIR) (B) images in short-axis views show subepicardial enhancement in the inferolateral wall at the base (arrowheads). Native T1 map shows corresponding abnormality (arrowheads in (C)) with elevated values (D) in the inferolateral wall compared with the interventricular septum. T2 mapping also showed abnormality in this region (arrows in (E)) with elevated values (F) when compared with the interventricular septum. Reprinted/adapted with permission from Ref. [15] 2021, Elsevier.
Figure 4. Magnetic Resonance Imaging of Case 2. Post-contrast magnitude inversion recovery (MAG-IR) (A) and phase-sensitive inversion recovery (PSIR) (B) images in short-axis views show subepicardial enhancement in the inferolateral wall at the base (arrowheads). Native T1 map shows corresponding abnormality (arrowheads in (C)) with elevated values (D) in the inferolateral wall compared with the interventricular septum. T2 mapping also showed abnormality in this region (arrows in (E)) with elevated values (F) when compared with the interventricular septum. Reprinted/adapted with permission from Ref. [15] 2021, Elsevier.
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Figure 5. Flow diagram of the study selection process. Preferred reporting items for systematic reviews and meta-analyses (PRISMA). Adapted from Moher et al.
Figure 5. Flow diagram of the study selection process. Preferred reporting items for systematic reviews and meta-analyses (PRISMA). Adapted from Moher et al.
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Table 1. Characteristics of Cases with Myocarditis Following COVID-19 Vaccination (n = 532).
Table 1. Characteristics of Cases with Myocarditis Following COVID-19 Vaccination (n = 532).
CharacteristicsNumber (%)
Gender
 male462 (86.8)
 female70 (13.2)
Age (range, y/o)12–80
Vaccine type
 Pfizer-BioNTech367 (69)
 Moderna137 (25.8)
 Janssen/Johnson & Johnson6 (1.1)
 AstraZeneca12 (2.3)
 COVAXIN1 (0.1)
 unknown9 (1.7)
Vaccine status
 first dosage62 (11.6)
 second dosage333 (62.6)
 booster dosage7 (1.4)
 unknown130 (24.4)
Patients’ presentation
 chest pain429 (80.6)
 fever/chills245 (46)
 myalgia132 (24.8)
 headache87 (16.3)
 shortness of breath161 (30.2)
 fatigue71 (13.3)
 nausea/vomiting65 (12.2)
Comorbidities
 hypertension34 (6.4)
 coronary artery disease10 (1.9)
 autoimmune disease17 (3.2)
 myocarditis history7(1.3)
 others *45 (8.4)
Outcome
 discharged500 (94)
 readmitted1 (0.1)
 expired3 (0.6)
 unknown28 (5.3)
Each bold words are the name of a characteristic. * Other comorbidities include cancer, type 2 diabetes, asthma, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), Von Willebrand disease, anxiety disorder, and Lennox–Gastaut syndrome.
Table 2. Cardiac MRI Findings of Study Cases based on the vaccine’s type.
Table 2. Cardiac MRI Findings of Study Cases based on the vaccine’s type.
Vaccine TypeLocation of Enhancement
(Based on Cardiac MRI Reported)
Epicardial/SubepicardialPericardial
Pfizer-BioNTech23220
Moderna709
Janssen/Johnson & Johnson20
AstraZeneca83
Unknown type60
Total31832
Noted. Some of the cases had multiple locations of enhancement.
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Keshavarz, P.; Yazdanpanah, F.; Emad, M.; Hajati, A.; Nejati, S.F.; Ebrahimian Sadabad, F.; Azrumelashvili, T.; Mizandari, M.; Raman, S.S. Myocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 Studies. Tomography 2022, 8, 1959-1973. https://doi.org/10.3390/tomography8040164

AMA Style

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(4):1959-1973. https://doi.org/10.3390/tomography8040164

Chicago/Turabian Style

Keshavarz, Pedram, Fereshteh Yazdanpanah, Maryam Emad, Azadeh Hajati, Seyed Faraz Nejati, Faranak Ebrahimian Sadabad, Tamta Azrumelashvili, Malkhaz Mizandari, and Steven S. Raman. 2022. "Myocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 Studies" Tomography 8, no. 4: 1959-1973. https://doi.org/10.3390/tomography8040164

APA Style

Keshavarz, P., Yazdanpanah, F., Emad, M., Hajati, A., Nejati, S. F., Ebrahimian Sadabad, F., Azrumelashvili, T., Mizandari, M., & Raman, S. S. (2022). Myocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 Studies. Tomography, 8(4), 1959-1973. https://doi.org/10.3390/tomography8040164

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