Abstract 4137534: Troponin Can Predict Late Gadolinium Enhancement on Cardiac MRI in COVID-19 Vaccine-Associated Myocarditis

Background/Aim: We previously reported that late gadolinium enhancement (LGE) on cardiac MRI (CMR) was as high as 82% in pediatric patients with COVID-19 vaccine-associated myocarditis (C-VAM) despite mild clinical symptoms and normal left ventricular function. As LGE can be a harbinger for future adverse events including arrhythmias, heart failure or sudden cardiac death, we sought to identify predictors for LGE in C-VAM, specifically assessing troponin as a screening marker for C-VAM patients at risk for myocardial scarring who could then be referred for a confirmatory CMR with LGE. Methods: In this longitudinal multicenter retrospective observational study across 38 U.S. member institutions of the M yocarditis A fter C OVID V accination (MACiV) study network, 333 patients with C-VAM based on CDC criteria were included from April 2021 to November 2022. Data collected included demographics, laboratory values, clinical and cardiac imaging characteristics and outcomes. Using logistic regression, troponin levels at presentation were assessed as a log transformed continuous variable and categorized into tertiles. Results: The C-VAM patients were predominantly white (67%) adolescent males (91%, 15.7± 2.8 years). There were 216/333 (65%) patients who had both a reported troponin value and had a CMR. On univariate analysis, elevated troponin increased the probability of having LGE (OR=1.29, 95% CI: 1.06, 1.58, p=0.012). Even after controlling for age, race, sex, number of vaccine doses and left ventricular ejection fraction (OR=1.32, 95% CI: 1.06, 1.65, p=0.013). Patients >15 years compared to those ≤15 years of age were 2.94 (95% CI: 1.28, 6.75, p=0.011) times more likely to have LGE at presentation. Patients with troponin levels in the highest tertile compared to lowest tertile were 2.66 times (95% CI: 1.04, 6.83, p=0.042) more likely to have LGE along with a greater involvement > 4 AHA myocardial segments with LGE (p=0.004) Conclusions: Higher troponin values are associated with presence of late gadolinium enhancement on cardiac MRI in patients with COVID-19 vaccine-associated myocarditis. Troponin levels at presentation may facilitate risk stratification and function as a screening tool to identify those C-VAM patients with the greatest likelihood of myocardial scarring, who may benefit from undergoing CMR for tissue characterization.

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Journal
Circulation
Published
2024-11-12
DOI
https://doi.org/10.1161/circ.150.suppl_1.4137534
Primary Topic
Cardiac Imaging and Diagnostics
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article
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article

Abstract 4137534: Troponin Can Predict Late Gadolinium Enhancement on Cardiac MRI in COVID-19 Vaccine-Associated Myocarditis

Santosh C. Uppu, Lars Grosse‐Wortmann, Deepika Thacker, Steven A. Anderson et al.
Circulation
Cardiac Imaging and Diagnostics
article

Abstract 4137534: Troponin Can Predict Late Gadolinium Enhancement on Cardiac MRI in COVID-19 Vaccine-Associated Myocarditis

Santosh C. Uppu, Lars Grosse‐Wortmann, Deepika Thacker, Steven A. Anderson, Ravi Ashwath, Hunter C. Wilson, Aswathy Vaikom House, Victoria Maksymiuk, Nilanjana Misra, Matthew Cornicelli, Michael P. DiLorenzo, Jyoti Patel, Saira Siddiqui, Jonathan H. Soslow, Preeti Ramachandran, Adam L. Dorfman, Frank Han, Parham Eshtehardi, Shiraz A. Maskatia, Michael J. Campbell, Rebecca S. Beroukhim, Elizabeth Drugge, Jennifer Su, Sihong Huang, Sujatha Buddhe, Jeremy Steele, Brian Fonseca, Lakshmi Nagaraju, Danish Vaiyani, Puneet Bhatla, Christopher Mathis, Madhu Sharma, Jared Klein, Juan Carlos Muniz, Supriya Jain, Xander Jacquemyn
article en

Abstract

Background/Aim: We previously reported that late gadolinium enhancement (LGE) on cardiac MRI (CMR) was as high as 82% in pediatric patients with COVID-19 vaccine-associated myocarditis (C-VAM) despite mild clinical symptoms and normal left ventricular function. As LGE can be a harbinger for future adverse events including arrhythmias, heart failure or sudden cardiac death, we sought to identify predictors for LGE in C-VAM, specifically assessing troponin as a screening marker for C-VAM patients at risk for myocardial scarring who could then be referred for a confirmatory CMR with LGE. Methods: In this longitudinal multicenter retrospective observational study across 38 U.S. member institutions of the M yocarditis A fter C OVID V accination (MACiV) study network, 333 patients with C-VAM based on CDC criteria were included from April 2021 to November 2022. Data collected included demographics, laboratory values, clinical and cardiac imaging characteristics and outcomes. Using logistic regression, troponin levels at presentation were assessed as a log transformed continuous variable and categorized into tertiles. Results: The C-VAM patients were predominantly white (67%) adolescent males (91%, 15.7± 2.8 years). There were 216/333 (65%) patients who had both a reported troponin value and had a CMR. On univariate analysis, elevated troponin increased the probability of having LGE (OR=1.29, 95% CI: 1.06, 1.58, p=0.012). Even after controlling for age, race, sex, number of vaccine doses and left ventricular ejection fraction (OR=1.32, 95% CI: 1.06, 1.65, p=0.013). Patients >15 years compared to those ≤15 years of age were 2.94 (95% CI: 1.28, 6.75, p=0.011) times more likely to have LGE at presentation. Patients with troponin levels in the highest tertile compared to lowest tertile were 2.66 times (95% CI: 1.04, 6.83, p=0.042) more likely to have LGE along with a greater involvement > 4 AHA myocardial segments with LGE (p=0.004) Conclusions: Higher troponin values are associated with presence of late gadolinium enhancement on cardiac MRI in patients with COVID-19 vaccine-associated myocarditis. Troponin levels at presentation may facilitate risk stratification and function as a screening tool to identify those C-VAM patients with the greatest likelihood of myocardial scarring, who may benefit from undergoing CMR for tissue characterization.

CirculationVol. 150(Suppl_1)
Northside Hospital (US), University of Iowa (US), Boston Children's Hospital (US), Lurie Children's Hospital (US), Seattle Children's Hospital (US), United States Food and Drug Administration (US), Children's Mercy Hospital (US), Children's Hospital of Philadelphia (US), Children's Hospital of Los Angeles (US), Emory University (US), Oregon Health & Science University (US), Illinois College (US), Duke University (US), Palo Alto University (US), New York Medical College (US), Community Health Systems - Dupont Hospital (US), Yale University (US), NYU Langone Health (US), Children's Hospital Colorado (US), Goryeb Children's Hospital (US), Michigan United (US), Children's Hospital of Oklahoma (US), Cohen Children's Medical Center (US), Helen DeVos Children's Hospital (US), Children's Hospital of Michigan (US), Children's Hospital at Montefiore (US), Miami Children's Hospital (US), Johns Hopkins Hospital (US), Boston Children's Museum (US), Joe DiMaggio Children's Hospital (US), Shriners Hospitals for Children Medical Center - Lexington (US), UC Davis Children's Hospital (US), Columbia University (US), The University of Texas Health Science Center at Houston (US), University of Colorado Denver (US), Stanford University (US)
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Openalex Percentile: Top 66%
Cardiac Imaging and Diagnostics
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