Improved Diagnosis of COVID-19 Vaccine-Associated Myocarditis with Cardiac Scarring Identified by Cardiac Magnetic Resonance Imaging

Strategic Insights -

A recent study published in the journal Open Heart has shed light on the diagnosis of COVID-19 vaccine-associated myocarditis. Researchers from Monash University in Melbourne, Australia, have found that cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging can identify cardiac scar, which may improve diagnostic accuracy and prognostication.

The study, which involved 67 patients with COVID-19 vaccine-associated myocarditis, found that 20 patients (30%) had LGE on CMR, indicating cardiac scarring. At diagnosis, 13% of patients were classified as definite myocarditis, while 87% were classified as probable. However, with the integration of CMR-LGE data, 28% of patients were reclassified from probable to definite myocarditis.

Key Takeaways:

  • Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging can identify cardiac scar in patients with COVID-19 vaccine-associated myocarditis.
  • The presence of LGE on CMR can improve diagnostic accuracy and prognostication, indicating that CMR should be included in the diagnostic workup of these patients.
  • Without CMR at the time of diagnosis, almost one-third of patients are misclassified as probable rather than definite myocarditis.
  • The study involved 67 patients with COVID-19 vaccine-associated myocarditis, with a mean age of 30±13 years and 72% male.
  • The median time from vaccination to CMR evaluation was 548 (range 398-603) days.
  • LGE on CMR occurred in one-third of patients with COVID-19 vaccine-associated myocarditis.
  • The study was conducted by researchers from Monash University, including Dion Stub, Daryl Cheng, Nigel Crawford, Andrew J Taylor, Josephine Warren, Philip Lew, Annette Alafaci, Bryn Jones, and Rui Lun Ng.

Statistics:

  • 67 patients with COVID-19 vaccine-associated myocarditis underwent CMR evaluation.
  • 20 patients (30%) had LGE on CMR, indicating cardiac scarring.
  • At diagnosis, 13% of patients were classified as definite myocarditis, while 87% were classified as probable.
  • With the integration of CMR-LGE data, 28% of patients were reclassified from probable to definite myocarditis.

Sources:

  • Open Heart journal, 2025,12(2). (Open Heart - http://openheart.bmj.com)
  • BMJ Publishing Group.