Myocardial Inflammation on FDG PET/MRI and Clinical Outcomes in Symptomatic and Asymptomatic Participants after COVID-19 Vaccination

Constantin 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

doi:10.1148/ryct.220247

Myocardial Inflammation on FDG PET/MRI and Clinical Outcomes in Symptomatic and Asymptomatic Participants after COVID-19 Vaccination

Radiol Cardiothorac Imaging. 2023 Mar 9;5(2):e220247. doi: 10.1148/ryct.220247. eCollection 2023 Apr.

Authors

Constantin Arndt Marschner¹, Paaladinesh Thavendiranathan^{1

2

3}, Dakota Gustafson^{3

4}, Kathryn L Howe^{3

4

5}, Jason E Fish^{3

4}, Robert M Iwanochko², Rachel M Wald^{1

2}, Husam Abdel-Qadir^{2

6}, Slava Epelman^{2

3

4

7}, Angela M Cheung^{3

8}, Rachel Hong¹, Kate Hanneman^{1

3}

Affiliations

¹ Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.
² Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto.
³ Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Canada.
⁴ Department of Laboratory Medicine & Pathobiology, University Health Network (UHN), University of Toronto, Toronto.
⁵ Department of Vascular Surgery, University Health Network (UHN), University of Toronto, Toronto.
⁶ Cardiovascular Division, Women's College Hospital, University of Toronto, Toronto.
⁷ Department of Immunology, University of Toronto, Toronto, Canada.
⁸ Department of Medicine, University Health Network (UHN) and Sinai Health System (SHS), University of Toronto, Toronto, Canada.

Abstract

Purpose: To evaluate potential cardiac sequelae of COVID-19 vaccination at 2-month follow-up and relate cardiac symptoms to myocardial tissue changes on fluorodeoxyglucose (FDG) PET/MRI, blood biomarkers, health-related quality of life, and adverse outcomes.

Materials and methods: In this prospective study (ClinicalTrials.gov: NCT04967807), a convenience sample of individuals aged ≥17 years were enrolled after COVID-19 vaccination and were categorized as symptomatic myocarditis (new cardiac symptoms within 14 days of vaccination and met diagnostic criteria for acute myocarditis), symptomatic no myocarditis (new cardiac symptoms but did not meet criteria for myocarditis), and asymptomatic (no new cardiac symptoms). Standardized evaluation was performed 2 months after vaccination, including cardiac fluorine 18 FDG PET/MRI, blood biomarkers, and health-related quality of life. Statistical analysis included Kruskal-Wallis and Fisher exact tests.

Results: Fifty-four participants were evaluated a median of 72 days (IQR: 42, 91) after COVID-19 vaccination, 17 symptomatic with myocarditis (36±[SD]15 years, 13 males), 17 symptomatic without myocarditis (42±12 years, 7 males), and 20 asymptomatic (45±14 years, 9 males). No participants in the symptomatic without myocarditis or asymptomatic groups had focal FDG-uptake, myocardial edema or impaired ventricular function. Two participants with symptomatic myocarditis had focal FDG-uptake, and three had high T2 on MRI. Health-related quality of life was lower in the symptomatic myocarditis group than the asymptomatic group. There were no adverse cardiac events beyond myocarditis in any participant.

Conclusions: At two-month follow-up, FDG PET/MRI showed evidence of myocardial inflammation in 2/17 participants diagnosed with acute myocarditis early after COVID-19 vaccination, but not in symptomatic and asymptomatic participants without acute myocarditis.Keywords: Myocarditis, Vaccination, COVID-19, PET/MRI, Cardiac MRI, FDG-PET.

Keywords: COVID-19; Cardiac MRI; FDG-PET; Myocarditis; PET/MRI; Vaccination.

Associated data

ClinicalTrials.gov/NCT04967807