Medium-term outcomes of myocarditis and pericarditis following BNT162b2 vaccination among adolescents in Hong Kong

Figures & data

Table 1. Patient characteristics and investigations.

Pt no	Age/Sex	Dx	Level of certainty	Duration of Follow-up (days)	First or second dose?	BW Change (kg)	Symptoms on follow-up	Peak Troponin (hsTnI/hsTnT/TnI/TnT)* (ng/L)	cMRI findings at diagnosis	ECG during admission	Follow-up ECG	Echocardiogram during admission	Follow-up Echocardiogram	Treadmill testing
1	15/M	Perimyocarditis	Definite	95	Second	0.5	Asymptomatic	Peak TnI 2506 TnT 793	Normal biV fx, no PEF, patchy edema, diffuse EGE and patchy pericardial/subepicardial LGE	Transient 1st degree AVB; 3 mm STE in V3-V4	Normal	Normal fx. Incidental finding of small coronary fistula to pulmonary trunk	N/A	Normal
2	14/M	Myocarditis	Definite	66	Second	−1.0	Asymptomatic	TnI 6342 TnT 646	Evidence of myocarditis. Normal RV fx (RVEF 50.6%), borderline LV fx (LVEF 51.5%). RLPV narrowing.	1st degree AVB; TWI III, avF; biphasic Ts V4-V6	N/A	Admission: borderline LV function, mild septal hypokinesia. Repeat echo pre-discharge: Satisfactory biventricular function	N/A	Normal
3	13/M	Perimyocarditis	Definite	88	Second	−0.2	Asymptomatic	TnT 1749	Normal biV volume, borderline biV fx (LVEF 52%, RVEF 46%). Evidence of perimyocarditis with LGE	2–4 mm STE in V3, V4, V6; STD in aVR, III, V1	Normal	Normal	N/A	Normal
4	13/F	Perimyocarditis	Definite	146	First	5.1	Asymptomatic	TnI 2974 TnT 302	Evidence of perimyocarditis. Borderline biV function (LVEF 52%, RVEF 40%)	2 mm in V5-V6; 1 mm STD in aVR, TWI in III	Normal	Normal	N/A	Normal
5	16/M	Perimyocarditis	Definite	106	Second	2.1	Admitted for severe chest pain 12 weeks after the initial admission, but normal ECG and Troponin	TnI 2882, TnT 948	Evidence of perimyocarditis with Edema, hyperemia and LGE. Small PEF. Borderline biV fx (LVEF 52%, RVEF 42%)	2–5 mm STE V2-V6; TWI aVL	Possible LVH, 2 mm STE in V3-V4	Normal LV function. Mildly impaired LV global longitudinal strain – 17%	N/A	Normal
6	15/M	Myocarditis	Definite	149	Second	N/A	Asymptomatic	hsTnI 11415	Normal biV fx. Evidence of myocarditis	Isolated PVC	Normal	Normal	N/A	Normal
7	15/M	Perimyocarditis	Definite	148	Second	−0.2	Asymptomatic	hsTnI 18507	LVEF 54.4%, increased STIR signal in the myocardium, faint patchy LGE, trace PEF	2 mm STE II, III, aVF, V5-V6; 2 mm STD V1-V2; Coved ST with TWI II, III, aVF, V4-V6	Normal	Borderline LV fx LVFS 28%, minimal pericardial effusion. Pre-discharge echocardiogram: normal LV fx LVFS 41%, small effusion	Normal	Normal
8	17/M	Perimyocarditis	Definite	178	First	1.1	Exercise-induced shortness of breath and tiredness from baseline 30 min to 10 min	hsTnI 19110	Evidence of myocarditis. LVEF 62%, RVEF 56%	1st degree AVB; Isolated PVC; 2 mm STE V2-V5	Normal	Tiny rim of PEF. Normal LV fx	Normal	Normal
9	14/F	Perimyocarditis	Definite	122	Second	−0.6	Asymptomatic	hsTnI 54.9	Evidence of perimyocarditis. LVEF 60%, RVEF 54%	2 mm STE in V4-V5	Normal	Normal	Normal	Normal
10	12/M	Perimyocarditis	Definite	107	Second	8.8	Asymptomatic	TnI 14766	Evidence of myocarditis	STE in V5-V6; STD in aVR, V1; TWI in III, aVF, V4	Normal	Normal LV fx. Thin rim of PEF at systole, hyperechoic left lateral and posterior pericardium	N/A	Normal
11	17/M	Perimyocarditis	Definite	146	Second	4.3	Exercise-induced chest pain during period of exercise restriction	hsTnI 30267	Normal biV fx, (LVEF 54%, RVEF 53%) Evidence of myocarditis, LGE of epicardium, small PEF	1st degree AVB; 2 mm STE II; 2–4 mm STE in V4-V6; 2 mm STD in aVR, V1; TWI III, biphasic Ts in V3-V4	Normal	Borderline contractility, no PEF Repeat echocardiogram 7 months later: normal biV fx	N/A	Normal
12	14/M	Perimyocarditis	Definite	66	Second	1.9	Asymptomatic	TnT 646	Evidence of myocarditis. LVEF 75%, RVEF 58%	2 mm STE in V2-V5; 1 mm STD in aVR, V1	Normal	Normal	N/A	N/A
13	14/M	Myocarditis	Definite	111	First	1.1	Asymptomatic	hsTnI 184	Myocardial edema without LGE	1st degree AVB; 1 mm II,III, aVF; TWI III	Normal	Normal	N/A	N/A
14	15/M	Myocarditis	Definite	89	Second	3.8	Chest pain after playing basketball at 3 months after admission	hsTnI 263	Normal biV fx (LVEF 62%, RVEF 58%). Very mild LGE, no edema. Very mild myocarditis.	2 mm STE in V3	Normal	Normal	N/A	N/A
15	15/M	Myocarditis	Definite	104	Second	2.3	Asymptomatic	TnI 2210	Myocarditis, normal LV size and fx LVEF 65%, borderline RV fx RVEF 49%, small PEF.	2 mm STE V2-V5; 1 mm STD in aVR; TWI in aVL	2 mm STE V3-V4; 1 mm STE in II, V5-V6; Q in I, aVL	Normal	Normal	Normal
16	12/F	Myocarditis	Definite	62	Second	4.9	Occasional tachycardia and palpitations (incidental findings of goiter and hyperthyroidism treated with propranolol and carbimazole)	hsTnI 566	Mild myocarditis as evidenced by subepicardial LGE, mild subepicardial edema. Normal biV fx (LVEF 59%, RVEF 57%)	1st degree AVB; sinus tachycardia	Normal	Normal	Normal	N/A
17	14/M	Myocarditis	Definite	77	First	N/A	Occasional shortness of breath at night during sleep. No other symptoms during daytime	hsTnI 3598	Evidence of myocarditis, normal biV function	2–4 mm STE V2-V6; Biphasic Ts V3-V5	N/A	Normal	N/A	N/A
18	14/M	Myocarditis	Probable	147	First	1.0	Asymptomatic	hsTnI 514	Equivocal EGE and edema of the myocardium due to motion artefacts	Normal	Normal	Normal	Normal	Normal
19	14/M	Myocarditis	Probable	149	Second	2.3	Vasovagal near-syncope	hsTnI 201	Normal	1st degree AVB, 1 mm STD in II, III, aVF; TWI in II, III, aVF	Normal except short PR 91 ms	Normal	N/A	Normal
20	15/M	Myocarditis	Probable	161	Second	6.6	Occasional chest discomfort lasting for 5–20 min, not associated with physical activity	hsTnT 25	Depressed biV fx (LVEF 51.6%, RVEF 45.5%), no evidence of myocarditis	Normal	Normal	Normal	Normal:	N/A
21	12/F	Myocarditis	Probable	164	Second	0.5	Asymptomatic	hsTnI 141	No evidence of myocarditis. No PEF.VEF 72%, RVEF 57%	TWI in III	N/A	Mild increase LV free wall echogenicity Normal LV fx	N/A	Normal
22	13/M	Myocarditis	Probable	75	Second	1.6	Asymptomatic	hsTnT 517	T2 mild myocardial edema, no evidence of myocarditis	2 mm II in V4	Normal	N/A	Normal	N/A
23	14/M	Perimyocarditis	Probable	73	First	N/A	Asymptomatic	hsTnT 103	LVEF 56.7%, delayed subepicardial enhancement, small rim PEF	N/A	Normal	Normal	N/A	N/A
24	14/M	Myocarditis	Probable	75	Second	N/A	Asymptomatic	TnI 21678	Normal biV fx, no PEF, no evidence of myocarditis	2–5 mm STE in V3-V4; 1 mm STD aVR; TWI aVL; biphasic Ts in aVF	N/A	Normal	Normal	Normal
25	16/M	Myocarditis	Possible	72	Second	0.5	Exercise tolerance lower than before	Normal TnT (peak CRP 35.6)	No evidence of myocarditis, LVEF 66%, RVEF 58%	1st degree AVB, 2 mm STE in V2-V4	Normal	N/A	N/A	N/A
26	14/M	Myocarditis	Possible	61	Second	N/A	Asymptomatic	hsTnI 3617	No evidence of myocarditis LVEF 65.1%	Short PR, Flat T waves in III	Normal	Normal	N/A	N/A
27	17/M	Myocarditis	Possible	75	First	−7.0	Intermittent left sided chest pain both at rest and during activities	TnI 103	No evidence of myocarditis LVEF 62.9%, RVEF 56%	Early repolarization	Normal	Normal	N/A	N/A
28	12/M	Myocarditis	Possible	73	First	2.3	Asymptomatic	hsTnI 1692	N/A	Normal	Normal	Normal	N/A	N/A

AVB – atrioventricular block; biV – biventricular; BW – bodyweight; cMRI – cardiac magnetic resonance imaging; CRP – C-reactive protein; Dx – Diagnoses; EGE – early gadolinium enhancement; fx – function; hsTnI – high-sensitivity troponin I; hsTnT – high-sensitivity troponin T; LGE – late gadolinium enhancement; LV – left ventricle; LVEF – left ventricular ejection fraction; LVFS – left ventricular fractional shortening; N/A – not available; PEF – pericardial effusion; RVEF – right ventricular ejection fraction; RLPV – right lower pulmonary vein; STD – ST depression; STE – ST elevation; ST1R – Short-TI Inversion Recovery; TnI – troponin I; TnT – troponin T

*Cardiac enzymes of all patients normalized on discharge