Prognostic Value of Abnormal ECG and MRI Findings in Pre-Pandemic Myocarditis

Clinical Results are Associated with Important Outcomes

By Peter A. McCullough, MD, MPH

I am asked on a daily basis about patients with myocarditis and the long-term outcome. This is understandable with so many young individuals suffering unpredictable cardiac arrest after COVID-19 vaccination even several years ago. While there have not been sufficient large series with long-term follow-up published on COVID-19 vaccine myocarditis, we can look to other groups in prior time periods for inferences on what factors may be important in the deluge of vaccine cardiac patients in cardiology offices today.

Fischer et al evaluated 587 consecutive patients with suspected, pre-pandemic myocarditis who underwent CMR and ECG for 15 years. They followed patients for major adverse cardiovascular event (MACE) included all-cause death, hospitalization for heart failure, heart transplantation, documented sustained ventricular arrhythmia, or recurrent myocarditis.

Fischer K, Marggraf M, Stark AW, Kaneko K, Aghayev A, Guensch DP, Huber AT, Steigner M, Blankstein R, Reichlin T, Windecker S, Kwong RY, Gräni C. Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. PLoS One. 2020 Jan 10;15(1):e0227134. doi: 10.1371/journal.pone.0227134. PMID: 31923225; PMCID: PMC6953836.

Both the ECG and cardiac MRI results where prognostic for the composite outcome. Conversely, those with normal ECG and MRI findings had the lowest rates of cardiac events over 15 years. The importance of this study for our patients with COVID-19 vaccine myocarditis is that each patient and their family should know and keep their initial and follow-up ECG and MRI results. Hopefully normalization will confer the best overall outlook. Conversely, those with abnormal findings should have continued close follow-up.

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Peter A. McCullough, MD, MPH

President, McCullough Foundation

www.mcculloughfnd.org

Fischer K, Marggraf M, Stark AW, Kaneko K, Aghayev A, Guensch DP, Huber AT, Steigner M, Blankstein R, Reichlin T, Windecker S, Kwong RY, Gräni C. Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. PLoS One. 2020 Jan 10;15(1):e0227134. doi: 10.1371/journal.pone.0227134. PMID: 31923225; PMCID: PMC6953836.