DOI: 10.1161/circ.150.suppl_1.4137534 ISSN: 0009-7322

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

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