Supriya Jain, M.D., Leads Multicenter Study of Myocarditis in Teenagers after COVID-19 Vaccination

Supriya Jain, M.D., assistant professor of pediatrics and of radiology and clinical education liaison at NYMC, recently led a national multicenter study of myocarditis, an inflammation of heart muscle, following COVID-19 vaccination in teenagers. In the study, published in Pediatrics, cardiac imaging data were collected from hospitals from across the United States to help characterize myocarditis in adolescents after COVID-19 vaccination and understand its impact.

“In June 2021, the Centers for Disease Control and Prevention (CDC) observed a rate of post-vaccine myocarditis that was higher in adolescents and young adults than the expected baseline,” said Dr. Jain, a cardiac imaging specialist, who also serves as director of Pediatric Cardiac MRI/Advanced Cardiovascular Imaging at Maria Fareri Children’s Hospital, a major clinical affiliate of NYMC. “At that time, only small case series in the pediatric population with rudimentary information about the myocardium had been reported. To improve our understanding into the spectrum and severity of this rare complication, I decided to initiate and undertake this larger study with my colleagues from multiple institutions across the country, which was truly a collaborative effort.”  

To collect the necessary data for the retrospective study, a request went out to physicians who specialize in cardiovascular imaging to report such cases from their institution. Ultimately, 63 patients from across 16 US hospitals that were under 21 years old and 92 percent male with a diagnosis of myocarditis following COVID-19 vaccination were included and compared using cardiac imaging data to a cohort with multisystem inflammatory syndrome in children (MIS-C).

“Although myocarditis following immunizations against smallpox, influenza, and tetanus is well recognized, the experience in children with vaccine-associated myocarditis, other than following COVID-19 vaccination, is limited,” said Dr. Jain. “Importantly, myocarditis was not reported following the clinical trials of mRNA COVID-19 vaccines.”

While endomyocardial biopsy remains the confirmatory test in the diagnosis of myocarditis, its invasive nature, and the possibility of tissue sampling errors along with risks of cardiac perforation and arrhythmias limit its use, especially in children. “Cardiac magnetic resonance (CMR) imaging has emerged as the modality of choice to evaluate the myocardium, including in myocarditis, and that data proved invaluable for this study,” said Dr. Jain.

Ultimately, while evidence was found in the CMR imaging data of myocardial inflammation and injury following COVID-19 vaccination, the hospital course of the patients included for the most part was mild with quick clinical recovery.  

“While early clinical outcomes in these patients have been reassuring so far, the prognostic significance, long-term implications and mechanism of this myocardial injury needs to be studied further, especially as vaccination efforts are rolled out to younger children,” said Dr. Jain.

Recently, Dr. Jain was invited by the United Kingdom’s Joint Committee on Vaccination and Immunization Safety (JCVI) to serve as an expert at their meeting to help guide them in their vaccine strategy. Dr. Jain’s study and paper was also quoted at the recent FDA Advisory panel meeting.

She is now embarking on a larger, multi-center follow-up study to evaluate the long-term outcomes related to the myocardial injury noted on the cardiac MRI in these patients.