Myocardial Scarring Persists in Patients with COVID-19 Vaccine-Associated Myocarditis
The Longitudinal Study Includes More Than 400 Children, Adolescents, and Young Adults Across 38 Hospitals
The latest findings from the longitudinal multicenter study on COVID-19 vaccine-associated myocarditis (C-VAM), called MACiV (Myocarditis After COVID Vaccination), in 333 children, adolescents, and young adults led by Supriya Jain, M.D., FSCMR, FACC, FAAP, associate professor of pediatrics, radiology, and of public health, showed that while 82 percent of the patients in the study had evidence of myocardial injury on cardiac MRI at initial presentation, 60 percent of those patients had persistence of myocardial scarring on follow up examinations. The study, which is in pre-print in The Lancet, is supported by a Broad Agency Agreement of $1,997,031 by the Food and Drug Administration.
“The clinical mid-term outcomes have been reassuring, though so far. Cardiac symptoms and arrhythmias are still very rare, and we have not seen any cardiac-related deaths or need for heart transplantation as the result of C-VAM to date among the patients in our study,” said Dr. Jain. “However, these are adolescents and while these myocardial scars have lessened in severity over time, we do not know if they will be risk factors for future adverse events including arrhythmias or heart failure. So it’s prudent to continue to follow up with these patients over the next few years.”
The multicenter study across 38 hospitals in the U.S. compared the clinical and cardiac imaging characteristics in the C-VAM patients with those in 100 multisystem inflammatory syndrome in children (MIS-C) patients, using advanced cardiovascular imaging, including cardiac MRI (CMR). MIS-C is a condition in which pediatric patients experience a hyper-immune response six to eight weeks after the COVID-19 infection and also can result in cardiac complications.
“While the CVAM patients were characterized with a milder initial clinical presentation, the myocardial injury was more common, in contrast to the MIS-C patients who in fact, had been much sicker,” said Dr.Jain, who previously presented the study at the prestigious 8th World Congress of Pediatric Cardiology and Pediatric Surgery, held in Washington, D.C. in 2023, where it was recognized as the best research in pediatric cardiology, first out of 900 abstracts.
This latest publication builds on earlier studies initiated and led by Dr. Jain that began with 63 patients from across 16 U.S. hospitals who were under 21 years old with a diagnosis of myocarditis following COVID-19 vaccination. Since that time, Dr. Jain has built a large collaborative research network of clinical investigators with expertise in both cardiology and advanced cardiovascular imaging, including cardiac MRI, that spans medical institutions across the U.S. As part of this longitudinal study, she plans to follow these patients long-term and has been working closely with the FDA.