Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it?
IntroductionAlthough myocarditis after anti-SARS-CoV-2 vaccination is increasingly recognized, we have little data regarding the course of the disease and, consequently, the imaging findings, including the tissue-specific features. The purpose of this study is to describe the clinical, immunological...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.961031/full |
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| author | Hajnalka Vago Hajnalka Vago Liliana Szabo Liliana Szabo Zsofia Szabo Zsuzsanna Ulakcsai Zsuzsanna Ulakcsai Emese Szogi Gizella Budai Attila Toth Vencel Juhasz Zsofia Dohy Krisztina Hoffer David Becker Robert Gabor Kiss Gergely Gyorgy Nagy Gyorgy Nagy Gyorgy Nagy Gyorgy Nagy Bela Merkely Bela Merkely |
| author_facet | Hajnalka Vago Hajnalka Vago Liliana Szabo Liliana Szabo Zsofia Szabo Zsuzsanna Ulakcsai Zsuzsanna Ulakcsai Emese Szogi Gizella Budai Attila Toth Vencel Juhasz Zsofia Dohy Krisztina Hoffer David Becker Robert Gabor Kiss Gergely Gyorgy Nagy Gyorgy Nagy Gyorgy Nagy Gyorgy Nagy Bela Merkely Bela Merkely |
| author_sort | Hajnalka Vago |
| collection | DOAJ |
| description | IntroductionAlthough myocarditis after anti-SARS-CoV-2 vaccination is increasingly recognized, we have little data regarding the course of the disease and, consequently, the imaging findings, including the tissue-specific features. The purpose of this study is to describe the clinical, immunological, and cardiac magnetic resonance (CMR) features of myocarditis after COVID-19 immunization in the acute phase and during follow-up. We aimed to compare the trajectory of the disease to myocarditis cases unrelated to COVID-19.MethodsWe assembled a CMR-based registry of potentially COVID-19 vaccination-related myocarditis cases. All patients who experienced new-onset chest pain and troponin elevation after COVID-19 vaccination and imaging confirming the clinical suspicion of acute myocarditis were enrolled in our study. Participants underwent routine laboratory testing and testing of their humoral and cellular immune response to COVID-19 vaccination. Clinical and CMR follow-up was performed after 3–6 months. We included two separate, sex- and age-matched control groups: (1) individuals with myocarditis unrelated to COVID-19 infection or vaccination confirmed by CMR and (2) volunteers with similar immunological exposure to SARS-CoV-2 compared to our group of interest (no difference in the number of doses, types and the time since anti-SARS-CoV-2 vaccination and no difference in anti-nucleocapsid levels).ResultsWe report 16 CMR-confirmed cases of myocarditis presenting (mean ± SD) 4 ± 2 days after administration of the anti-SARS-CoV-2 vaccine (male patients, 22 ± 7 years), frequently with predisposing factors such as immune-mediated disease and previous myocarditis. We found that 75% received mRNA vaccines, and 25% received vector vaccines. During follow-up, CMR metrics depicting myocardial injury, including oedema and necrosis, decreased or completely disappeared. There was no difference regarding the CMR metrics between myocarditis after immunization and myocarditis unrelated to COVID-19. We found an increased T-cell response among myocarditis patients compared to matched controls (p < 0.01), while there was no difference in the humoral immune response.ConclusionIn our cohort, myocarditis occurred after both mRNA and vector anti-SARS-CoV-2 vaccination, frequently in individuals with predisposing factors. Upon follow-up, the myocardial injury had healed. Notably, an amplified cellular immune response was found in acute myocarditis cases occurring 4 days after COVID-19 vaccination. |
| first_indexed | 2024-04-12T19:12:44Z |
| format | Article |
| id | doaj.art-904826f6c0da49fb9d8c6224cd59a7bd |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T19:12:44Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-904826f6c0da49fb9d8c6224cd59a7bd2022-12-22T03:19:50ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-09-01910.3389/fcvm.2022.961031961031Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it?Hajnalka Vago0Hajnalka Vago1Liliana Szabo2Liliana Szabo3Zsofia Szabo4Zsuzsanna Ulakcsai5Zsuzsanna Ulakcsai6Emese Szogi7Gizella Budai8Attila Toth9Vencel Juhasz10Zsofia Dohy11Krisztina Hoffer12David Becker13Robert Gabor Kiss14Gergely Gyorgy Nagy15Gyorgy Nagy16Gyorgy Nagy17Gyorgy Nagy18Bela Merkely19Bela Merkely20Heart and Vascular Center, Semmelweis University, Budapest, HungaryDepartment of Sports Medicine, Semmelweis University, Budapest, HungaryHeart and Vascular Center, Semmelweis University, Budapest, HungaryQueen Mary University of London, London, United KingdomDepartment of Laboratory Medicine, Semmelweis University, Budapest, HungaryHeart and Vascular Center, Semmelweis University, Budapest, HungaryDepartment of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, HungaryMilitary Hospital, Budapest, HungaryBorsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, University of Debrecen, Debrecen, HungaryHeart and Vascular Center, Semmelweis University, Budapest, HungaryHeart and Vascular Center, Semmelweis University, Budapest, HungaryHeart and Vascular Center, Semmelweis University, Budapest, HungaryDepartment of Radiology, Erzsébet Teaching Hospital and Rehabilitation Institute of Sopron, Sopron, HungaryHeart and Vascular Center, Semmelweis University, Budapest, HungaryMilitary Hospital, Budapest, HungaryBorsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, University of Debrecen, Debrecen, HungaryHeart and Vascular Center, Semmelweis University, Budapest, HungaryDepartment of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary0Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, HungaryHeart and Vascular Center, Semmelweis University, Budapest, HungaryDepartment of Sports Medicine, Semmelweis University, Budapest, HungaryIntroductionAlthough myocarditis after anti-SARS-CoV-2 vaccination is increasingly recognized, we have little data regarding the course of the disease and, consequently, the imaging findings, including the tissue-specific features. The purpose of this study is to describe the clinical, immunological, and cardiac magnetic resonance (CMR) features of myocarditis after COVID-19 immunization in the acute phase and during follow-up. We aimed to compare the trajectory of the disease to myocarditis cases unrelated to COVID-19.MethodsWe assembled a CMR-based registry of potentially COVID-19 vaccination-related myocarditis cases. All patients who experienced new-onset chest pain and troponin elevation after COVID-19 vaccination and imaging confirming the clinical suspicion of acute myocarditis were enrolled in our study. Participants underwent routine laboratory testing and testing of their humoral and cellular immune response to COVID-19 vaccination. Clinical and CMR follow-up was performed after 3–6 months. We included two separate, sex- and age-matched control groups: (1) individuals with myocarditis unrelated to COVID-19 infection or vaccination confirmed by CMR and (2) volunteers with similar immunological exposure to SARS-CoV-2 compared to our group of interest (no difference in the number of doses, types and the time since anti-SARS-CoV-2 vaccination and no difference in anti-nucleocapsid levels).ResultsWe report 16 CMR-confirmed cases of myocarditis presenting (mean ± SD) 4 ± 2 days after administration of the anti-SARS-CoV-2 vaccine (male patients, 22 ± 7 years), frequently with predisposing factors such as immune-mediated disease and previous myocarditis. We found that 75% received mRNA vaccines, and 25% received vector vaccines. During follow-up, CMR metrics depicting myocardial injury, including oedema and necrosis, decreased or completely disappeared. There was no difference regarding the CMR metrics between myocarditis after immunization and myocarditis unrelated to COVID-19. We found an increased T-cell response among myocarditis patients compared to matched controls (p < 0.01), while there was no difference in the humoral immune response.ConclusionIn our cohort, myocarditis occurred after both mRNA and vector anti-SARS-CoV-2 vaccination, frequently in individuals with predisposing factors. Upon follow-up, the myocardial injury had healed. Notably, an amplified cellular immune response was found in acute myocarditis cases occurring 4 days after COVID-19 vaccination.https://www.frontiersin.org/articles/10.3389/fcvm.2022.961031/fullmyocarditisSARS-CoV-2 immunizationcardiovascular magnetic resonanceimmunological responsevaccinationinflammation |
| spellingShingle | Hajnalka Vago Hajnalka Vago Liliana Szabo Liliana Szabo Zsofia Szabo Zsuzsanna Ulakcsai Zsuzsanna Ulakcsai Emese Szogi Gizella Budai Attila Toth Vencel Juhasz Zsofia Dohy Krisztina Hoffer David Becker Robert Gabor Kiss Gergely Gyorgy Nagy Gyorgy Nagy Gyorgy Nagy Gyorgy Nagy Bela Merkely Bela Merkely Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it? Frontiers in Cardiovascular Medicine myocarditis SARS-CoV-2 immunization cardiovascular magnetic resonance immunological response vaccination inflammation |
| title | Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it? |
| title_full | Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it? |
| title_fullStr | Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it? |
| title_full_unstemmed | Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it? |
| title_short | Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it? |
| title_sort | immunological response and temporal associations in myocarditis after covid 19 vaccination using cardiac magnetic resonance imaging an amplified t cell response at the heart of it |
| topic | myocarditis SARS-CoV-2 immunization cardiovascular magnetic resonance immunological response vaccination inflammation |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.961031/full |
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