Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination

Abstract

Purpose To evaluate cardiac MRI characteristics in patients with suspected hypersensitivity myocarditis following mRNA COVID-19 vaccination.

Materials and Methods Patients clinically suspected of acute myocarditis after COVID-19 vaccination were retrospectively analyzed and compared against a healthy control group. Cardiac MRI protocol included parameters such as T1 and T2 relaxation times, extracellular volume (ECV), T2 signal intensity ratio, and late gadolinium enhancement (LGE). Lymph node size was assessed in the patient group on the injection side. Student t-test, analyses of variance (ANOVA) with Tukey post-hoc test, and χ² test were used for statistical analysis.

Results 20 patients with clinically suspected post-vaccine myocarditis (28 ± 12 years; 12 men) and 40 controls (31 ± 11 years; 25 men) were evaluated. According to the 2018 Lake Louise criteria (LLC), patients with clinically suspected myocarditis were further subdivided into an LLC-positive group (n = 9) and an LLC-negative group (n = 11). The mean time of symptom onset after vaccination was 1.1 ± 1.2 days (LLC-positive) and 6.5 ± 9.2 days (LLC-negative). Group differences in inflammatory variables between myocarditis patients and control subjects were more pronounced in the LLC-positive group (e. g., T1 relaxation time: 1041 ± 61 ms [LLC positive] vs. 1008 ± 79 ms [LLC-negative] vs. 970 ± 25 ms [control]; p <.001; or T2 signal intensity ratio 2.0 ± 0.3 vs. 1.6 ± 0.3 [LLC-negative] and vs. 1.6 ± 0.3 [control], p = .012). LLC-positive patients were significantly faster in receiving an MRI after initial symptom onset (8.8 ± 6.1 days vs. 52.7 ± 33.4 days; p = .001) and had higher troponin T levels (3938 ± 5850 ng/l vs. 9 ± 11 ng/l; p <.001). LGE lesions were predominantly located at the subepicardium of the lateral wall. Axillary lymphadenopathy was more frequent in the LLC-positive group compared to the LLC-negative group (8/9 [89 %] vs. 0/11 [0 %], p < 0.001).

Conclusion Vaccine-induced myocarditis should be considered in patients with acute symptom onset after mRNA vaccination, especially if elevated serum troponin T is observed. Imaging findings of vaccine-induced myocarditis are similar to virus-induced myocarditis, allowing for the use of the Lake Louise Criteria for diagnostic purposes.

Key Points: 

• Vaccine-induced hypersensitivity myocarditis can be confirmed with cardiac MRI

• Especially patients with sudden onset of symptoms and elevated serum troponin T had positive cardiac MRI findings

• Cardiac MRI characteristics of vaccine-induced myocarditis are similar to those in virus-induced myocarditis

Citation Format

• Kravchenko D, Isaak A, Mesropyan N et al. Cardiac MRI in Suspected Acute Myocarditis After COVID-19 mRNA Vaccination. Fortschr Röntgenstr 2022; 194: 1003 – 1011

Zusammenfassung

Ziel Analyse der kardialen MRT-Befunde bei Patienten mit Hypersensitivitätsmyokarditis nach mRNA-COVID-19-Impfung.

Material und Methoden Patienten mit klinischem Verdacht auf akute Myokarditis nach mRNA-COVID-19-Impfung wurden retrospektiv analysiert und mit einer gesunden Kontrollgruppe verglichen. Das Herz-MRT-Protokoll enthielt Parameter wie T1- und T2-Relaxationszeiten, extrazelluläres Volumen (EZV), die T2-Signalintensitätsratio und Late Gadolinium Enhancement (LGE). Die axilläre Lymphknotengröße bei den Patienten wurde auf der Impfseite bestimmt. Für die statistische Analyse wurden der Student-t-Test, Varianzanalysen (ANOVA) mit Tukey-Post-hoc-Test und der χ²-Test verwendet.

Ergebnisse 20 Patienten mit Verdacht auf Myokarditis nach Impfung (28 ± 12 Jahre; 12 Männer) und 40 Kontrollen (31 ± 11 Jahre; 25 Männer) wurden analysiert. Gemäß der 2018er Lake-Louise-Kriterien (LLC) wurden die Patienten in eine LLC-positive Gruppe (n = 9) und eine LLC-negative Gruppe (n = 11) unterteilt. Die mittlere Zeit nach Impfung bis zum Symptombeginn betrug 1,1 ± 1,2 Tage (LLC-positiv) bzw. 6,5 ± 9,2 Tage (LLC-negativ). Die Gruppenunterschiede der Entzündungsparameter zwischen Myokarditispatienten und Kontrollen waren in der LLC-positiven Gruppe ausgeprägter (z. B. T1-Relaxationszeit: 1041 ± 61 ms [LLC-positiv] vs. 1008 ± 79 ms [LLC-negativ] vs. 970 ± 25 ms [Kontrolle], p <,001; oder T2-Signalintensitätsratio 2.0 ± 0.3 vs. 1.6 ± 0.3 [LLC negativ] und vs. 1.6 ± 0.3 [Kontrolle], p = ,012). LLC-positive Patienten erhielten nach Symptombeginn schneller ein MRT (8,8 ± 6,1 Tage vs. 52,7 ± 33,4 Tage; p = ,001) und hatten höhere Troponin T-Werte (3938 ± 5850 ng/l vs. 9 ± 11 ng/l; p <,001). LGE-Läsionen waren überwiegend subepikardial in der Lateralwand lokalisiert. Axilläre Lymphadenopathien waren in der LLC-positiven Gruppe häufiger als in der LLC-negativen Gruppe (8/9 [89 %] vs. 0/11 [0 %] p <,001).

Schlussfolgerung Eine Myokarditis nach mRNA-Impfung sollte bei akutem Auftreten von Symptomen vermutet werden, insbesondere bei erhöhten Troponin-Werten. Die MRT-Befunde einer impfinduzierten Myokarditis sind mit denen einer virusinduzierten Myokarditis vergleichbar, sodass die Lake-Louise-Kriterien zur Diagnosebestätigung angewendet werden können.

Kernaussagen: 

• Hypersensitivitätsmyokarditiden nach stattgehabter mRNA-Impfung können mit der kardialen MRT bestätigt werden

• Insbesondere Patienten mit plötzlichem Symptombeginn und erhöhtem Troponin T hatten auffällige MRT-Befunde

• Die MRT-Befunde einer impfungsinduzierten Myokarditis waren vergleichbar mit denen viraler Myokarditiden

Key words

vaccine - myocarditis - cardiac MRI - COVID-19

Publikationsverlauf

Eingereicht: 15. Oktober 2021

Angenommen: 14. Januar 2022

Artikel online veröffentlicht:
10. März 2022

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