Table 1.
Characteristics and outcomes of patients with myocarditis following COVID-19 vaccination
| Variable | Case number |
Reference value | ||||
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | |||
| Age (years) | 53 | 22 | 19 | 22 | ||
| Gender | Female | Male | Male | Male | ||
| Race/ethnicity | White | White | White | White | ||
| Comorbidities | Depression, hyperlipidemia | Asthma, kidney stone | None | Asthma, fibrous dysplasia | ||
| Vaccine type | mRNA-1273 | mRNA-1273 | mRNA-1273 | mRNA-1273 | ||
| Vaccine dose | First | Second | Second | Second | ||
| Days: vaccine to hospital | 6 | 3 | 4 | 3 | ||
| Body mass index (kg/m2) | 28.7 | 34.9 | 28 | 24 | ||
| Vital signs on arrival | ||||||
| Temperature (°F) | 96.8 | 99.5 | 99.6 | 98.7 | ||
| Heart rate (beats/min) | 112 | 84 | 76 | 138 | ||
| Blood pressure (mm Hg) | 86/60 | 152/79 | 119/69 | 119/69 | ||
| Respiratory rate (breaths/min) | 17 | 22 | 14 | 20 | ||
| Chest x-ray | Enlarged cardiac silhouette | Enlarged cardiac silhouette | Normal | Normal | ||
| Electrocardiogram | 1st AV block; 3rd AV block later | Normal | Diffuse ST elevations | Diffuse ST elevation | ||
| Echocardiogram | ||||||
| Day from admission | 2 | 2 | 1 | 2 | ||
| LVEF (%) | 60–64 | 55–59 | 65–69 | 60–64 | ≥55 | |
| TAPSE (cm) | 2.1 | 1.9 | 2 | 2 | <1.7 | |
| Right heart catheterization | ||||||
| Day from admission | 4 | 1 | Not done | Not done | ||
| RA pressure (mm Hg) | 26 | 8 | 2.0–6.0 | |||
| RV pressure (mm Hg) | ||||||
| Systolic | 40 | 30 | 15–25 | |||
| Diastolic | 11 | 8 | 0–8 | |||
| PA pressure (mm Hg) | ||||||
| Systolic | 44 | 23 | 15–25 | |||
| Diastolic | 23 | 14 | 8.0–15.0 | |||
| PCWP | 29 | 12 | 6.0–12.0 | |||
| Cardiac output (L/min) | 3.54 | 7 | 4.0–8.0 | |||
| Cardiac index (min × m2) | 1.82 | 2.7 | 2.5–4.0 | |||
| Cardiac MRI | ||||||
| Day after presentation | 8 | 5 | 3 | 25 | ||
| LVEF (%) | 45 | 60 | 53 | 54 | ||
| RVEF (%) | 35 | 44 | 46 | 45 | ||
| LGE abnormality | 0 | + | + | 0 | ||
| Increased T2 signal | 0 | + | 0 | 0 | ||
| Laboratory tests | ||||||
| WBC (K/µL) | 14 | 11.54 | 5.73 | 23.4 | 4.23–9.07 | |
| Hemoglobin (g/dL) | 11.2 | 15 | 15.8 | 15.5 | 13.7–17.5 | |
| Platelet count (K/µL) | 379 | 202 | 230 | 288 | 163–337 | |
| BUN (mg/dL) | 20 | 11 | 11 | 14 | 6.0–20.0 | |
| Creatinine (mg/dL) | 0.8 | 0.8 | 0.9 | 1 | 0.5–1.2 | |
| Creatine kinase (IU/L) | 340 (day 1) | 421 (day 3) | 1747 (day 1) | 111 (day 1) | 26–308 | |
| hs-cTnT (ng/L) | ≤19.0 | |||||
| At presentation | 1582 | 958 | 1509 | 90.3 | ||
| Peak | 1582 (day 1) | 1254 (day 4) | 2472 (day 2) | 90.3 (day 1) | ||
| At discharge | 41.5 (day 12) | 195 (day 8) | 210.6 (day 8) | 25.6 (day 4) | ||
| At follow-up (weeks after discharge) | <6 (2 weeks) | 16.3 (5 weeks) | 13.1 (1 week) | N/A | ||
| Pro-BNP (pg/mL) | 9401 (day 1) | 400 (day 1) | 149 (day 6) | 730 | ≤124 | |
| Peak Pro-BNP (pg/mL) | 14,933 (day 7) | 400 (day 1) | 149 (day 6) | 730 (day 1) | ||
| D-dimer (ng/mL) | 684 | N/A | N/A | N/A | ≤500 | |
| ESR (mm/h) | 0–30 | |||||
| Initial | 12 (day 4) | 14 (day 1) | 15 (day 2) | 29 (day 1) | ||
| Peak | 21 (day 12) | 14 (day 1) | 15 (day 2) | 29 (day 1) | ||
| CRP (mg/dL) | 0.0–0.5 | |||||
| Initial | 15 (day 4) | 5.4 (day 1) | 3.1 (day 2) | 7 (day 1) | ||
| Peak | 15 (day 4) | 5.4 (day 1) | 3.1 (day 2) | 12.4 (day 2) | ||
| Total bilirubin (mg/dL) | 0.4 | 0.3 | 0.5 | 0.7 | 0.0–1.0 | |
| AST (IU/L) | 160 | 72 | 30 | 25 | 5.0–37.0 | |
| ALT (IU/L) | 169 | 41 | 78 | 32 | 5.0–41.0 | |
| ALP (IU/L) | 58 | 56 | 78 | 136 | 35–129 | |
| Ferritin (ng/mL) | 14,345 (day 11) | 234 (day 6) | 92.7 (day 2) | NA | 13–150 | |
| TSH (µIU/mL) | 0.08 | 2.94 | 0.23 | 1.86 | 0.27–4.20 | |
| Free T4 (ng/mL) | 1.47 | 1.23 | 1.15 | 1.24 | 0.93–1.70 | |
| Lactate (mmol/L) | 3.2 | NA | NA | 1.4 | 0.5–2.2 | |
| ANA | Negative | Negative | Negative | Not done | ||
| Ig E (IU/mL) | 104 | Not done | Not done | Not done | 1.53–114 | |
| Clinical course | ||||||
| Hospitalization (days) | 11 | 8 | 7 | 4 | ||
| Methylprednisolone protocol | + | + | + | + | ||
| IV immunoglobulin | + | 0 | + | 0 | ||
ALT indicates alanine transaminase; ANA, antinuclear antibodies; AST, aspartate aminotransferase; BUN, blood urea nitrogen; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; hs-cTnT, high-sensitivity cardiac troponin T; IV, intravenous; LGE, late gadolinium enhancement; LVEF, left ventricular ejection fraction; MRI, magnetic resonance imaging; PA, pulmonary artery; PCWP, pulmonary capillary wedge pressure; Pro-BNP, pro-brain natriuretic peptide; RA, right atrial; RV, right ventricular; RVEF, right ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion; TSH, thyroid-stimulating hormone; WBC, white blood cell.