背景:已经报道了严重急性呼吸道冠状病毒2(SARS-CoV-2)疫苗接种后心脏炎症的罕见病例。
目的:研究在急性和亚急性期使用心血管磁共振成像(MRI)进行的2019年冠状病毒病后急性炎症(COVID-19)Pfizer/BioNTech疫苗接种的儿科患者。
方法:我们招募了18岁以下的青少年,他们在2021年7月至2022年8月期间在两个机构之一就诊,并在COVID-19辉瑞/BioNTech疫苗接种后不久发现了急性心肌炎的临床和实验室检查结果。他们都使用机构性心肌炎方案进行了心血管MRI检查。
结果:5名青少年(4名男孩)在COVID-19疫苗接种后出现症状后3天至109天(平均49天)之间接受了8次扫描。在出现时(症状发作后3-12天),三名青少年在短tau倒置恢复(STIR)T2加权图像上出现了心肌水肿。在这些孩子中,心血管MRI随访时(首次MRI后53~68天),心肌水肿/急性炎症已消退.然而,在所有三个青少年中,在后续行动中,钆晚期增强的持续区域很明显,提示心肌纤维化后。一个青少年只扫描了一次,有症状后66天,没有急性炎症,但持续的纤维化变化。这个最后的青少年,在症状出现109天后接受了第一次扫描,发现与先前的心肌炎发作相符,伴有轻度持续性局部心肌水肿/炎症。
结论:这项关于疫苗后心肌炎的研究表明,在Pfizer/BioNTech疫苗接种几周后,初始心肌水肿消退后,残留病变具有钆增强/心肌纤维化的持续区域,并伴有持续的心肌水肿。迫切需要认识并充分研究疫苗接种后心肌炎的结果。
Rare cases of cardiac inflammation following vaccination for severe acute respiratory coronavirus 2 (SARS-CoV-2) have been reported.
To study paediatric patients with clinical findings of acute inflammation post coronavirus disease 2019 (COVID-19) Pfizer/BioNTech vaccination using cardiovascular magnetic resonance imaging (MRI) in acute and subacute phases.
We enrolled adolescents younger than 18 years who presented at one of two institutions between July 2021 and August 2022 with clinical and laboratory findings of acute myocarditis shortly following COVID-19 Pfizer/BioNTech vaccination. They all underwent cardiovascular MRI using the institutional myocarditis protocol.
Five adolescents (four boys) underwent eight scans between 3 days and 109 days (mean 49 days) after the onset of symptoms following COVID-19 vaccination. Myocardial oedema appeared on short tau inversion recovery (STIR) T2-weighted images in three adolescents at presentation (3-12 days after symptom onset). In these children, the myocardial oedema/acute inflammation had resolved at follow-up cardiovascular MRI (53-68 days after first MRI). However, in all three adolescents, a persistent area of late gadolinium enhancement was evident at follow-up, suggesting post-myocarditic fibrosis. One adolescent scanned only once, 66 days after being symptomatic, had no acute inflammation but persistent fibrotic changes. This last adolescent, who underwent the first scan 109 days after symptom onset, had findings compatible with an episode of previous myocarditis, with mild ongoing regional myocardial oedema/inflammation.
This study on post-vaccine myocarditis demonstrates residual lesions with persistent areas of late gadolinium enhancement/myocardial fibrosis with ongoing myocardial oedema after resolution of the initial myocardial oedema a few weeks after Pfizer/BioNTech vaccination. There is an urgent need to recognise and fully investigate the outcome of post-vaccination myocarditis.