COVID-19 Vaccine Myocarditis Not Healing

As a cardiologist, my two greatest fears concerning COVID-19 vaccine myocarditis are: 1) sudden cardiac death, 2) permanent damage to the heart resulting in scar.

The reason why scar is important is because it puts the patient at risk for two late complications: 1) malignant arrhythmias and cardiac arrest, 2) development of dilated cardiomyopathy and heart failure.

In clinical practice I have observed a few patients with small areas of damage (<15% of the left ventricle with late gadolinium enhancement) return to normal on follow-up cardiac MRI. However I remain concerned about patients with larger areas of damage.

Warren and colleagues studied patients with COVID-19 vaccine myocarditis with serial MRI data and the following abstract results:

“Sixty-seven patients with C-VAM (mean age 30 ± 13 years, 72% male) underwent CMR evaluation. Median time from vaccination to CMR was 548 (range 398-603) days. Twenty patients (30%) had persistent LGE, most frequently found in the basal inferolateral segment (n = 11). At diagnosis, nine patients (13%) were classified as definite and 58 (87%) as probable myocarditis.

With integration of CMR LGE data, 16 patients (28%) were reclassified from probable to definite myocarditis. Persistent LGE on CMR occurs in one third of patients with C-VAM. Without CMR at diagnosis, almost one third of patients are misclassified as probable rather than definite myocarditis.”

However, it was Table 3 that caught my eye—particularly those with baseline and follow up MRI scans completed out to 556 days.

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