Purpose of Review

Coronavirus disease-2019 (COVID-19) vaccines have been related to rare cases of acute myocarditis, occurring between 1 in 10,000 and 1 in 100,000 individuals, approximately. Incidence of COVID-19 vaccine-associated myocarditis varies with age, sex, and type of vaccine. Although most patients with acute myocarditis temporally associated with COVID-19 vaccines have an uneventful course, a small subpopulation presents with cardiogenic shock (termed fulminant myocarditis [FM]). This review explored the prevalence, clinical presentation, management, and prognosis of COVID-19 vaccine-associated acute myocarditis, specifically focusing on FM and comparing patients with fulminant versus non-fulminant myocarditis.

Recent Findings

Cases of FM represent about 2–4% (0 to 7.5%) of COVID-19 vaccine-associated acute myocarditis cases, and mortality is around 1%, ranging between 0 and 4.4%. First, we identified 40 cases of FM up to February 2023 with sufficient granular data from case reports and case series of COVID-19 vaccine-associated acute myocarditis that occurred within 30 days from the last vaccine injection. This population was compared with 294 cases of non-fulminant acute myocarditis identified in the literature during a similar time. Patients with FM were older (48 vs. 27 years), had a larger proportion of women (58% vs. 9%), and mainly occurred after the first shot compared with non-fulminant cases (58% vs. 16%). The reported mortality was 27% (11 out of 40), in line with non-vaccine-associated fulminant myocarditis. These data were in agreement with 36 cases of FM from a large Korean registry. Herein, we reviewed the clinical features, imaging results, and histological findings of COVID-19 vaccine-associated fulminant myocarditis.

Summary

In conclusion, COVID-19 vaccine-associated FM differs from non-fulminant forms, suggesting potential specific mechanisms in these rare and severe forms. Mortality in vaccine-associated FM remains high, in line with other forms of FM.

中文翻译：

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暴发性心肌炎与 COVID-19 疫苗接种暂时相关

审查目的

2019 冠状病毒病 (COVID-19) 疫苗与罕见的急性心肌炎病例有关，发生率约为万分之一至十万分之一。 COVID-19 疫苗相关心肌炎的发病率因年龄、性别和疫苗类型而异。尽管大多数暂时与 COVID-19 疫苗相关的急性心肌炎患者病程平稳，但仍有一小部分患者出现心源性休克（称为暴发性心肌炎 [FM]）。本综述探讨了 COVID-19 疫苗相关急性心肌炎的患病率、临床表现、治疗和预后，特别关注 FM 并比较暴发性与非暴发性心肌炎患者。

最近的发现

FM 病例约占 COVID-19 疫苗相关急性心肌炎病例的 2-4%（0 至 7.5%），死亡率约为 1%，范围在 0 至 4.4% 之间。首先，我们确定了截至 2023 年 2 月的 40 例 FM 病例，并从上次疫苗注射后 30 天内发生的 COVID-19 疫苗相关急性心肌炎病例报告和病例系列中获得了足够的详细数据。该人群与文献中同期发现的 294 例非暴发性急性心肌炎病例进行了比较。与非暴发性病例相比，FM 患者年龄较大（48 岁 vs. 27 岁），女性比例较高（58% vs. 9%），并且主要发生在第一次注射后（58% vs. 16%）。报告的死亡率为 27%（40 例中有 11 例），与非疫苗相关的暴发性心肌炎一致。这些数据与韩国大型登记处的 36 例 FM 病例一致。在此，我们回顾了 COVID-19 疫苗相关暴发性心肌炎的临床特征、影像学结果和组织学发现。

概括

总之，与 COVID-19 疫苗相关的 FM 与非暴发性形式不同，表明这些罕见和严重形式的潜在特定机制。与其他形式的 FM 一样，疫苗相关 FM 的死亡率仍然很高。