TY - JOUR
T1 - Myocarditis and coronavirus disease 2019 vaccination
T2 - A systematic review and meta-summary of cases
AU - Saputra, Pandit Bagus Tri
AU - Kurniawan, Roy Bagus
AU - Trilistyoati, Desy
AU - Al Farabi, Makhyan Jibril
AU - Susilo, Hendri
AU - Alsagaff, Mochamad Yusuf
AU - Oktaviono, Yudi Her
AU - Sutanto, Henry
AU - Gusnanto, Arief
AU - Wungu, Citrawati Dyah Kencono
PY - 2023
Y1 - 2023
N2 - Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been an increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases were male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated with the risk of myocarditis following the administration of the first dose (p < 0.01; OR, 5.74; 95% CI, 2.42-13.64), indicating that its primary mechanism is immune mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant non-invasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of <12%, and mortality of <2%. The majority was treated with non-steroidal anti-inflammatory drugs, colchicine, and steroids. Deceased cases had characteristics of being female, older age, non-chest pain symptoms, first-dose vaccination, left ventricular ejection fraction of <30%, fulminant myocarditis, and eosinophil infiltrate histopathology. Systematic review registration: PROSPERO (CRD42021271806).
AB - Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been an increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases were male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated with the risk of myocarditis following the administration of the first dose (p < 0.01; OR, 5.74; 95% CI, 2.42-13.64), indicating that its primary mechanism is immune mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant non-invasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of <12%, and mortality of <2%. The majority was treated with non-steroidal anti-inflammatory drugs, colchicine, and steroids. Deceased cases had characteristics of being female, older age, non-chest pain symptoms, first-dose vaccination, left ventricular ejection fraction of <30%, fulminant myocarditis, and eosinophil infiltrate histopathology. Systematic review registration: PROSPERO (CRD42021271806).
KW - Myocarditis
KW - coronavirus disease 2019 (COVID-19) vaccination
KW - vaccine
KW - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
KW - side effect
KW - SARS-COV-2 VACCINATION
KW - MAGNETIC-RESONANCE
KW - FULMINANT MYOCARDITIS
KW - COVID-19 VACCINATION
KW - COLCHICINE
U2 - 10.17305/bb.2022.8779
DO - 10.17305/bb.2022.8779
M3 - (Systematic) Review article
C2 - 36803547
SN - 2831-0896
VL - 23
SP - 546
EP - 567
JO - Biomolecules & Biomedicine
JF - Biomolecules & Biomedicine
IS - 4
ER -