IMPORTANCE Vaccine-associated myocarditis is an unusual entity that has been described for the smallpox vaccine, but only anecdotal case reports have been described for other vaccines. Whether COVID-19 vaccination may be linked to the occurrence of myocarditis is unknown.OBJECTIVE To describe a group of 7 patients with acute myocarditis over 3 months, 4 of whom had recent messenger RNA (mRNA) COVID-19 vaccination.DESIGN, SETTING, AND PARTICIPANTS All patients referred for cardiovascular magnetic resonance imaging at Duke University Medical Center were asked to participate in a prospective outcomes registry. Two searches of the registry database were performed: first, to identify patients with acute myocarditis for the 3-month period between February 1 and April 30 for 2017 through 2021, and second, to identify all patients with possible vaccine-associated myocarditis for the past 20 years. Once patients with possible vaccine-associated myocarditis were identified, data available in the registry were supplemented by additional data collection from the electronic health record and a telephone interview.EXPOSURES mRNA COVID-19 vaccine. MAIN OUTCOMES AND MEASURESOccurrence of acute myocarditis by cardiovascular magnetic resonance imaging. RESULTSIn the 3-month period between February 1 and April 30, 2021, 7 patients with acute myocarditis were identified, of which 4 occurred within 5 days of COVID-19 vaccination. Three were younger male individuals (age, 23-36 years) and 1 was a 70-year-old female individual. All 4 had received the second dose of an mRNA vaccine (2 received mRNA-1273 [Moderna], and 2 received BNT162b2 [Pfizer]). All presented with severe chest pain, had biomarker evidence of myocardial injury, and were hospitalized. Coincident testing for COVID-19 and respiratory viruses provided no alternative explanation. Cardiac magnetic resonance imaging findings were typical for myocarditis, including regional dysfunction, late gadolinium enhancement, and elevated native T1 and T2.CONCLUSIONS AND RELEVANCE In this study, magnetic resonance imaging findings were found to be consistent with acute myocarditis in 7 patients; 4 of whom had preceding COVID-19 vaccination. Further investigation is needed to determine associations of COVID-19 vaccination and myocarditis.
The sensitivity limitations for magnetic resonance imaging of organic molecules have recently been addressed by hyperpolarization methods, which prepare excess nuclear spin polarization. This approach can increase sensitivity by orders of magnitude, but the enhanced signal relaxes away in tens of seconds, even in favorable cases. Here we show theoretically that singlet states between strongly coupled spins in molecules can be used to store and retrieve population in verylong-lived disconnected eigenstates, as long as the coupling between the spins substantially exceeds both the couplings to other spins and the resonance frequency difference between them. Experimentally, 2,3-carbon-13-labeled diacetyl has a disconnected eigenstate that can store population for minutes and is read out by hydration to make the two spins inequivalent.Magnetic resonance imaging of different endogenous and exogenous molecules in tissue and living organisms holds the promise of resolving metabolic pathways and diagnosing early disease states, thus broadly affecting pharmaceutical development and molecular medicine. However, magnetic resonance is extremely insensitive, mainly because even very large magnetic fields induce only a very small nuclear magnetization at room temperature. For example, hydrogen atoms in a 7-T imager have ~0.0001 of the bulk magnetization they would have if all spins were aligned in the same direction. As a result, virtually all clinical magnetic resonance images measure water signal, and localized magnetic resonance spectroscopy is challenging and slow.This signal limitation has spurred the development of so-called hyperpolarization methods, which commonly produce bulk magnetizations of 20% or more. Although the first applications used spin-polarized noble gases (1) (for instance, 3 He and 129 Xe), in recent years attention has turned to two methods that can hyperpolarize molecules: (i) para-H 2 addition across double bonds (2-4) and (ii) dynamic nuclear polarization (DNP) (5-13). The DNP methodology in particular is very versatile, and hundreds of different molecules have been polarized, but virtually all in vivo work has focused on one molecule ( 13 C-labeled pyruvate), largely because the population relaxation time T 1 is relatively long (40 s at 14.1 T). The polarized nuclei can undergo metabolic reactions before the nuclear magnetic resonance (NMR) signal returns to thermal equilibrium and becomes undetectable. Generically, 13 C T 1 values are tens of seconds for carbons without attached protons (and much shorter with attached protons), and hydrogen T 1 values are shorter still. This lifetime permits some important metabolic processes to be studied, but it is vastly shorter than the lifetimes associated with other molecular imaging modalities (e.g., 18 F positron emission tomography, which decays in ~2 hours).* To whom correspondence should be addressed. warren.warren@duke.edu. We present a practical approach to storing and retrieving population from very-long-lived spin states in a fairly wide ran...
IMPORTANCE Stress cardiac magnetic resonance imaging (CMR) is not widely used in current clinical practice, and its ability to predict patient mortality is unknown. OBJECTIVE To determine whether stress CMR is associated with patient mortality. DESIGN, SETTING, AND PARTICIPANTS Real-world evidence from consecutive clinically ordered CMR examinations. Multicenter study of patients undergoing clinical evaluation of myocardial ischemia. Patients with known or suspected coronary artery disease (CAD) underwent clinical vasodilator stress CMR at 7 different hospitals. An automated process collected data from the finalized clinical reports, deidentified and aggregated the data, and assessed mortality using the US Social Security Death Index. MAIN OUTCOMES AND MEASURES All-cause patient mortality. RESULTS Of the 9151 patients, the median (interquartile range) patient age was 63 (51-70) years, 55% were men, and the median (interquartile range) body mass index was 29 (25-33) (calculated as weight in kilograms divided by height in meters squared). The multicenter automated process yielded 9151 consecutive patients undergoing stress CMR, with 48 615 patient-years of follow-up. Of these patients, 4408 had a normal stress CMR examination, 4743 had an abnormal examination, and 1517 died during a median follow-up time of 5.0 years. Using multivariable analysis, addition of stress CMR improved prediction of mortality in 2 different risk models (model 1 hazard ratio [HR], 1.83; 95% CI, 1.63-2.06; P < .001; model 2: HR, 1.80; 95% CI, 1.60-2.03; P < .001) and also improved risk reclassification (net improvement: 11.4%; 95% CI, 7.3-13.6; P < .001). After adjustment for patient age, sex, and cardiac risk factors, Kaplan-Meier survival analysis showed a strong association between an abnormal stress CMR and mortality in all patients (
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