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Vaccination-Associated Myocarditis and Myocardial Injury.
Natasha L Altman1, Amber A Berning2, Sarah C Mann3
1Division of Cardiology, Department of Medicine (N.L.A., R.A.Q., E.A.G., M.R.B.), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora.
Circulation Research
|May 11, 2023
Summary
SARS-CoV-2 vaccine-associated myocarditis is rare, primarily linked to mRNA vaccines. While COVID-19 infection poses a higher risk, vaccine-associated cases show faster recovery and less severe outcomes.
Area of Science:
- Cardiology
- Immunology
- Vaccinology
Background:
- SARS-CoV-2 vaccine-associated myocarditis requires evaluation alongside COVID-19 infection and other myocarditis causes.
- Myocardial injury from COVID-19 vaccines may involve inflammatory infiltrates or microvascular thrombosis.
Purpose of the Study:
- To analyze the incidence, characteristics, and outcomes of SARS-CoV-2 vaccine-associated myocarditis.
- To compare vaccine-associated myocarditis with COVID-19 infection and other forms of myocarditis.
Main Methods:
- Clinical diagnosis based on symptoms and cardiac MRI.
- Endomyocardial biopsy for confirmatory diagnosis of myocarditis.
- Incidence rate calculation for mRNA vaccines (BNT162b2, mRNA-1273) in specific age groups.
Main Results:
- Myocarditis incidence rates per 100,000 individuals after two mRNA vaccine doses are approximately 1.9 (BNT162b2) and 3.5 (mRNA-1273).
- COVID-19 infection shows a 3.5-fold increased myocarditis incidence compared to controls, versus 1.5-fold for BNT162b2 and 6.2-fold for mRNA-1273.
- Vaccine-associated myocarditis demonstrates lower mortality and morbidity with faster recovery compared to COVID-19 infection.
Conclusions:
- mRNA vaccines are associated with a low incidence of myocarditis, primarily in young males.
- Vaccine-associated myocarditis generally follows a more benign clinical course than COVID-19-related myocarditis.
- The risk-benefit profile favors vaccination, given the more severe outcomes associated with COVID-19 infection.
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