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Patients recovering from COVID-19 vaccine–associated myocarditis continue to exhibit diastolic dysfunction and reduced myocardial strain at long-term follow-up.
A new long-term clinical study provides important insights into the cardiac outcomes of myocarditis occurring after COVID-19 vaccination, revealing that while most patients show biochemical recovery, mild heart dysfunction and ongoing symptoms may persist for years.
Researchers followed patients who developed myocarditis within 50 days of COVID-19 vaccination between 2021 and 2022, reassessing them nearly 2 years after their initial hospitalization. The aim was to determine long-term cardiac function, inflammatory activity, and symptom burden, and to compare outcomes with patients who developed myocarditis unrelated to vaccination. Patients underwent a comprehensive follow-up assessment approximately 28 ± 6 months after hospital admission.
Evaluations encompassed echocardiography, electrocardiography, cardiac and inflammatory biomarkers, lung ultrasound, and standardized symptom questionnaires. Outcomes in vaccine-associated myocarditis (V-myocarditis) were compared with those in non-vaccine-related myocarditis (NV-myocarditis) patients admitted during the same period. The study followed 17 patients with V-myocarditis, with a median age of 47 years (range 27–59); 53% were women.
Symptoms developed rapidly after vaccination, with a median onset of 6 days, and 88% of patients required hospital admission within 30 days. At long-term follow-up, patients illustrated mild impairment of left ventricular function, reflected by a median global longitudinal strain (GLS) of 16.0%. In 71% of people, diastolic dysfunction was present. In contrast, right ventricular function and lung ultrasound findings remained preserved, suggesting no prominent long-term pulmonary or right-sided cardiac involvement. Biochemical recovery was largely reassuring.
Levels of cardiac troponin-I and C-reactive protein declined markedly from admission to follow-up, indicating resolution of acute myocardial injury and systemic inflammation. However, 35% of patients continued to depict evidence of low-grade inflammation, highlighting incomplete inflammatory recovery in a notable proportion. Despite normalization of most biomarkers, symptoms were common nearly 2 years later. Fatigue was reported by 35% of patients, and 41% continued to experience chest pain, underscoring the long-term symptom burden linked with the condition. When compared with NV-myocarditis patients, those with vaccine-linked myocarditis showed similar symptom prevalence and biomarker recovery.
However, left ventricular strain remained lower in the vaccine-associated group at follow-up (18.5% in NV-myocarditis vs. 16.0% in V-myocarditis), suggesting subtle but persistent differences in cardiac mechanics. These findings suggest that clinical recovery does not always equate to complete myocardial normalization. Even in people with resolved inflammation, subclinical left ventricular dysfunction and chronic symptoms may persist, underscoring the importance of long-term cardiovascular surveillance.
Open Heart
Long-term effects on cardiac function and symptoms in patients with myocarditis following COVID-19 vaccination: the ECHOVID-19 Long-term Study
Mohammad Nizar Ramadan et al.
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