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Myocarditis and Pericarditis following COVID-19 vaccination in adolescents
Session:
Posters (Sessão 6 - Écran 6) - Doença Cardiovascular em Populações Especiais 2 - Covid 19
Speaker:
João Oliveira Dias
Congress:
CPC 2022
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.14 Cardiovascular Disease in Special Populations - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Oliveira Dias; Joana Marinho; Fernanda Rodrigues; António Pires
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In adolescents, myocarditis and pericarditis are known, rare complications, of COVID-19 mRNA vaccines, affecting mostly males. The pathophysiological mechanisms remain unclear, but most cases have a mild acute clinical course. However, the long-term effects are still uncertain.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In Portugal, COVID-19 vaccination in adolescents started in mid-August 2021 for the over 16-year-old and in late August for the over 12-year-old groups. Within 3 months, 87% of this population was inoculated (data: Direção Geral da Saúde).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In this report we aim to characterize the adolescent population with COVID-19 vaccine related myocarditis (C-VAM) in a single tertiary referral centre in Portugal.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 6 cases of myocarditis were reported and are currently being followed-up, 5 males, with a median age of 15,5 years [13-17]. All patients received the Pfizer-BioNTech COVID vaccine, and all but one had C-VAM following the second dose given 3 weeks after the first. The median onset of symptoms was 2 days [1-4] following vaccine administration. Two of these patients also had pericarditis.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All common causes of myocarditis/pericarditis were excluded, including ongoing Covid-19 infection. None met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All patients presented with precordial pain and two with fever. Mean peak troponin I levels were 6586ng/L [1219-16290ng/L]. Echocardiographic changes were present in 3 (50%) of the patients, two presenting with mild systolic dysfunction and one with mild pericardial effusion. All changes resolved within 7 days of admission. Patients with isolated myocarditis were managed with ibuprofen, and those with associated pericarditis were also given colchicine. Mean hospital stay was 5,7 days (range 5-7 days). Cardiac magnetic resonance imaging (C-MRI) was performed within 1 month of presentation and findings were normal in all but one patient, who had hyperintense signal in T2-weighted images, showing myocardial edema.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">As of the time of submission, 5 of the 6 patients had undergone 24h Holter monitoring, with one patient having ST-T changes in the left precordial leads. This patient had a recurrent episode of myopericarditis 3 weeks post discharge. Only one patient underwent a treadmill exercise test, which was normal.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with C-VAM had a mostly favorable early clinical evolution. However, continued clinical monitoring is recommended due to the uncertain pathophysiology and long-term outcomes.</span></span></p>
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