Gadolinium changes detected on cardiovascular magnetic resonance imaging following COVID-19 vaccine-related myocarditis in adolescents

Dear Editors,

Using cardiovascular magnetic resonance imaging (MRI) in the acute and subacute phases, Krupickova et al. studied paediatric patients with clinical findings of acute inflammation following coronavirus illness 2019 (COVID-19) Pfizer/BioNTech vaccine [1]. A few weeks after receiving the Pfizer/BioNTech vaccination, after the initial myocardial oedema had subsided, Krupickova et al. concluded that there were persistent areas of late gadolinium enhancement/myocardial fibrosis with ongoing myocardial oedema [1]. Below, we outline some reservations.

First, there are scant clinical data on the physical and immunological state of vaccine recipients prior to injection, therefore pinpointing the exact clinical relationship may be difficult. Comorbidities are rarely discussed in published studies, even when they are — due to the paucity of information on the health and immunological status of vaccine recipients prior to injection — establishing the precise therapeutic link might occasionally be difficult.

Second, comorbidities of the patient might exacerbate findings. Concurrent medical disorders impacting clinical outcomes is a serious issue [2].

Finally, the immunological response to the COVID-19 vaccine may be influenced by genetic background [3]. The genetic component needs further investigation.

In conclusion, it is difficult to pinpoint the precise clinical link between the MRI findings and vaccination in the paper by Krupickova et al. [1] because of a lack of detailed information. More research is needed to rule out other aggravating factors, such as genetic predisposition and comorbidity. Given that there is insufficient data, Krupickova et al. [1] cannot conclusively link their MRI findings directly to the Pfizer/BioNTech vaccination.

Declarations

Conflicts of interest

None