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HomeRadiologyVol. 304, No. 3 PreviousNext CommunicationsFree AccessLetters to the EditorCardiac MRI and Clinical Follow-up in COVID-19 Vaccine–associated MyocarditisMatteo Fronza*,†, Paaladinesh Thavendiranathan*,†,‡, Gauri Rani Karur*,†, Husam Abdel-Qadir‡,§, Jacob A. Udell‡,§, Rachel M. Wald*,†,‡, Kate Hanneman*,† Matteo Fronza*,†, Paaladinesh Thavendiranathan*,†,‡, Gauri Rani Karur*,†, Husam Abdel-Qadir‡,§, Jacob A. Udell‡,§, Rachel M. Wald*,†,‡, Kate Hanneman*,† Author AffiliationsDepartment of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2Department of Medical Imaging, Women's College Hospital, University of Toronto, TorontoDivision of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, TorontoCardiovascular Division, Women's College Hospital, University of Toronto, Torontoemail: [email protected]Matteo Fronza*,†Paaladinesh Thavendiranathan*,†,‡Gauri Rani Karur*,†Husam Abdel-Qadir‡,§Jacob A. Udell‡,§Rachel M. Wald*,†,‡Kate Hanneman*,† Published Online:May 3 2022https://doi.org/10.1148/radiol.220802MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Editor:We previously reported cardiac MRI findings in a cohort of patients with COVID-19 vaccine–associated myocarditis in an in-press article published online in Radiology in February 2022 (1). The majority of patients had mild imaging abnormalities at the time of acute symptoms. However, little is known about later evolution of the cardiac MRI abnormalities.The institutional ethics committee approved this retrospective analysis and waived the requirement for written informed consent. Cardiac MRI examinations were performed at 1.5 T or 3.0 T (Siemens) and were analyzed blinded to all clinical information (Circle cmr42). Global longitudinal, circumferential, and radial strain was analyzed using feature-tracking analysis. Late gadolinium enhancement (LGE) was quantified by using a signal intensity threshold of 4 SD. Maximum native T1 and T2 were converted to z scores by using scanner-specific local reference values (1).Thirteen patients underwent follow-up cardiac MRI (mean age, 33 years ± 14; 77% men) (Table). All patients presented with chest pain that followed mRNA-1273 in nine (69%) and BNT162b2 in four (31%) patients. Six patients (46%) required hospitalization. Six patients were treated with colchicine (46%), three were treated with aspirin (23%), and three were treated with ibuprofen (23%).Baseline and Follow-up FindingsAt follow-up MRI (median, 100 days after vaccination; IQR, 74–237), myocardial edema had resolved in all patients (Table). LGE had resolved in three of 13 (23%), decreased in eight of 13 (62%), and remained absent in two of 13 (15%) patients. In patients with residual LGE, the extent at follow-up was minimal (range, 1–2 g). Left ventricular ejection fraction increased and was normal in all at follow-up (56% ± 4 vs 60% ± 3; P = .003).Median clinical follow-up duration was 159 days (IQR, 107–232 days). All patients were asymptomatic with normal troponin levels and no adverse cardiac events (death, sustained atrial or ventricular arrhythmia lasting ≥ 30 seconds, or heart failure hospitalization).In summary, in our case series of 13 patients with acute myocarditis after COVID-19 vaccination, follow-up MRI showed resolution of myocardial edema, normalization of left ventricular function, and interval decrease in LGE. These findings are consistent with the typical rapid decrease in myocardial inflammation in other causes of myocarditis (2). However, minimal LGE without edema was present in 62% of patients at follow-up, likely reflecting myocardial fibrosis. In conjunction with lack of any adverse events at 5-month follow-up, this raises the likelihood that vaccine-associated myocarditis might have a favorable prognosis despite the persistence of minimal LGE.Disclosures of conflicts of interest: M.F. No relevant relationships. P.T. No relevant relationships. G.R.K. No relevant relationships. H.A.Q. No relevant relationships. J.A.U. Grants to author institution from AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Novartis, Sanofi. R.M.W. No relevant relationships. K.M. Payment for lectures from Sanofi Genzyme, Amicus, Medscape; participation on a data safety board or advisory board from Sanofi Genzyme.References1. Fronza M, Thavendiranathan P, Chan V, et al. Myocardial Injury Pattern at MRI in COVID-19 Vaccine-associated Myocarditis. Radiology 2022;304(3):553–562. Link, Google Scholar2. Sanchez Tijmes F, Thavendiranathan P, Udell JA, Seidman MA, Hanneman K. Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 Vaccination. Radiol Cardiothorac Imaging 2021;3(6):e210252. Link, Google ScholarArticle HistoryPublished online: May 03 2022Published in print: Sept 2022 FiguresReferencesRelatedDetailsCited ByRadiology: Cardiothoracic Imaging Highlights 2022Domenico Mastrodicasa, Gilberto J. Aquino, Karen G. Ordovas, Daniel Vargas, Dominik Fleischmann, Suhny Abbara, Kate Hanneman, 15 June 2023 | Radiology: Cardiothoracic Imaging, Vol. 5, No. 3Myocardial Inflammation at FDG PET/MRI and Clinical Outcomes in Symptomatic and Asymptomatic Participants after COVID-19 VaccinationConstantin Arndt Marschner, Paaladinesh Thavendiranathan, Dakota Gustafson, Kathryn L. Howe, Jason E. Fish, Robert M. Iwanochko, Rachel M. Wald, Husam Abdel-Qadir, Slava Epelman, Angela M. Cheung, Rachel Hong, Kate Hanneman, 9 March 2023 | Radiology: Cardiothoracic Imaging, Vol. 5, No. 2Consenso de expertos sobre el diagnóstico y el tratamiento de la miocarditis asociada con infección o vacunación contra el SARS-CoV-2ManuelBarreiro-Pérez, PabloPastor Pueyo, SergioRaposeiras-Roubín, DoloresMontero Corominas, AitorUribarri, RocíoEiros Bachiller, JoséRozado Castaño, LuisaGarcía-Cuenllas Álvarez, LuisSerratosa Fernández, FernandoDomínguez, DomingoPascual Figal2023 | Revista Española de CardiologíaA narrative review of vaccine pharmacovigilance during mass vaccination campaigns: Focus on myocarditis and pericarditis after COVID‐19 mRNA vaccinationPierre‐PhilippePiché‐Renaud, Shaun K.Morris, Karina A.Top2023 | British Journal of Clinical Pharmacology, Vol. 89, No. 3Cardiac Imaging in Myocarditis: Current Evidence and Future DirectionsCamilaUrzua Fresno, FelipeSanchez Tijmes, Kirsten E.Shaw, FloraHuang, PaaladineshThavendiranathan, SharmilaKhullar, Michael A.Seidman, KateHanneman2023 | Canadian Association of Radiologists Journal, Vol. 74, No. 1Cardiac magnetic resonance follow-up of COVID-19 vaccine associated acute myocarditisDmitrijKravchenko, AlexanderIsaak, NarineMesropyan, Leon M.Bischoff, Claus C.Pieper, UlrikeAttenberger, DanielKuetting, SebastianZimmer, ChristopherHart, Julian A.Luetkens2022 | Frontiers in Cardiovascular Medicine, Vol. 9Recommended Articles Myocardial Injury Pattern at MRI in COVID-19 Vaccine–Associated MyocarditisRadiology2022Volume: 304Issue: 3pp. 553-562Myocardial Strain Evaluation with Cardiovascular MRI: Physics, Principles, and Clinical ApplicationsRadioGraphics2022Volume: 42Issue: 4pp. 968-990Layer-specific Strain Analysis with Cardiac MRI Feature Tracking in Acute MyocarditisRadiology: Cardiothoracic Imaging2022Volume: 4Issue: 3Early Diastolic Longitudinal Strain Rate at MRI and Outcomes in Heart Failure with Preserved Ejection FractionRadiology2021Volume: 301Issue: 3pp. 582-592Myocardial Inflammation at FDG PET/MRI and Clinical Outcomes in Symptomatic and Asymptomatic Participants after COVID-19 VaccinationRadiology: Cardiothoracic Imaging2023Volume: 5Issue: 2See More RSNA Education Exhibits Principles and Applications of Magnetic Resonance Myocardial Feature TrackingDigital Posters2020Acquisition Techniques and Applications of Strain Imaging in Cardiac Magnetic Resonance (CMR)Digital Posters2020Imaging of Acute and Chronic Cardiac Complications of COVID-19Digital Posters2022 RSNA Case Collection Chronic myocardial infarctionRSNA Case Collection2020Acute myocardial InfarctionRSNA Case Collection2021Acute pulmonary embolismRSNA Case Collection2022 Vol. 304, No. 3 Metrics Altmetric Score Open AccessThis article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. 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Cardiac MRI and Clinical Follow-up in COVID-19 Vaccine–associated Myocarditis