COVID-19 Vaccine-Induced Myocarditis: A Systemic Review and Literature Search

Abstract

Myocarditis is one of the complications reported with COVID-19 vaccines, particularly both Pfizer-BioNTech and Moderna vaccines. Most of the published data about this association come from case reports and series. Integrating the geographical data, clinical manifestations, and outcomes is therefore important in patients with myocarditis to better understand the disease. A thorough literature search was conducted in Cochrane library, PubMed, ScienceDirect, and Google Scholar for published literature till 30 March 2022. We identified 26 patients eligible from 29 studies; the data were pooled from these qualifying case reports and case series. Around 94% of patients were male in this study, the median age for onset of myocarditis was 22 years and 85% developed symptoms after the second dose. The median time of admission for patients to hospitals post-vaccination was three days and chest pain was the most common presenting symptom in these patients. Most patients had elevated troponin on admission and about 90% of patients had cardiac magnetic resonance imaging (CMR) that showed late gadolinium enhancement. All patients admitted with myocarditis were discharged home after a median stay of four days. Results from this current analysis show that post-mRNA vaccination myocarditis is mainly seen in young males after the second dose of vaccination. The pathophysiology of vaccine-induced myocarditis is not entirely clear and late gadolinium enhancement is a common finding on CMR in these patients that may indicate myocardial fibrosis or necrosis. Prognosis remains good and all patients recovered from myocarditis, however further studies are advisable to assess long-term prognosis of myocarditis.

Single-cell sequencing of PBMC characterizes the altered transcriptomic landscape of classical monocytes in BNT162b2-induced myocarditis

“…Although several case studies have reported clinical changes in BNT162b2-MyoC patients, our understanding of BNT162b2-MyoC is still limited mainly due to scarcity of tissue sampling and lack of empirical evidence ( 45 ). Moreover, based on published literature reviews ( 46 , 47 ), among few empirical studies that were conducted with tissue samples from patients, there hasn’t been research that featured detailed transcriptomic profile of the harvested tissues. Myocarditis is a local inflammation of the myocardium.…”

Cardiovascular complications of COVID-19 vaccines: A review of case-report and case-series studies

“…Pericarditis is a somewhat prevalent cause of chest pain, and around 5% of all hospitalizations for chest pain are due to pericarditis 119 . Myocarditis has been reported as a major side effect of these vaccines; however, the overall rate of post-COVID19 vaccination-myocarditis is around 1.62% which is very small 120 , 121 , 122 .…”

“…A recent systematic review on myocarditis after COVID-19 vaccination reported only one case after Astra Zeneca, one case after Sputnik V injection, and one case after vector Johnson & Johnson, out of a total of 277 cases 120 . A 32-year-old female case developed myocarditis on the third day after receiving the first dose of the AstraZeneca.…”

Myocarditis and Pericarditis Following the SARS-CoV-2 Infection and COVID-19 Vaccination

“…In this condition, cardiac enzymes, electrocardiography (ECG), and echocardiography are mandated, and if indicated, a CMR can also be performed (Figure 3). Notably, a systematic review of the COVID-19 vaccineinduced myocarditis showed that all patients underwent CMR, and CMR finding related to the myocarditis was evident in 89% of patients [65]. One must be careful not to immediately attribute all cardiac events to the vaccine, and other etiologies must be excluded [64].…”

“…Regardless of its etiology, NSAIDs, steroids, intravenous immunoglobulin, and colchicine are treatment options for myocarditis. It was shown that NSAIDs, colchicine, and steroids are the most frequent medications used to manage COVID-19 vaccine-induced myocarditis [65]. Regarding COVID-19 vaccine-induced myocarditis in pediatrics, NSAIDs were recommended as a first-line treatment option.…”