(566) Cardiogenic Shock with Fulminant Myocarditis Following Covid-19 Infection Tends to Have Slightly Worse Outcome Than That From Covid-19 Vaccinations

PURPOSE: Multiple reports of myocarditis after COVID-19 infection or COVID-19 vaccination exist, however, data is lacking on fulminant myocarditis leading to cardiogenic shock in this patient population. We conducted a literature search, on outcomes of fulminant myocarditis following COVID-19 infection or COVID-19 vaccination. METHODS: PubMed, Google scholar and EmBASE was used to conduct a systematic search of literature following the PRISMA guidelines. Keywords used included “COVID”, “COVID-19” and “Coronavirus” in combination with “vaccine”, “fulminant myocarditis”, “acute heart failure” and “cardiogenic shock”. Cases written in English with patients aged 18 years and above, containing data regarding clinical presentation, and outcomes among those with diagnosis of fulminant myocarditis following either COVID-19 infection or COVID-19 vaccination were selected for the analysis, after screening for duplicates. Selected publications were analyzed both qualitatively and quantitatively. RESULTS: A total of 100 publications were included in the analysis. Seventy-three cases had fulminant myocarditis following COVID-19 infection with 40 (54.8%) being males with mean age of 45.1±15.8 years. They were hypotensive and the lowest recorded left ventricular ejection fraction (LVEF) was 19.2±8.9%, recovering to 56.5±8.0%. Vasopressors and inotropes were used in 51 (69.9%), and mechanical circulatory support (MCS) in 55 (75.3%), including intra-aortic balloon pump (IABP) in (12/16.4%), Impella (5/6.8%) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in 38/52.1% of cases. The survival rate amongst this cohort was 60.3%. There were 27 cases of fulminant myocarditis in patients post COVID-19 vaccination with 11 (40.7%) being males. The mean age was 50.3±16.4 years and Pfizer vaccine was used in about 15 (55.5%). They were hypotensive and 20.8±9.7% was the lowest LVEF recorded, improving to 56.1±7.1%. Vasopressors and inotropes were used in 17 (63.0%), and MCS in 29 (>100% because more than one device was used in seven cases) including IABP (8/30.0%), Impella (9/33.3%) and VA-ECMO (12/44.4 %) of cases. This group had a survival rate of 70.3%. CONCLUSION: Fulminant myocarditis in patients following COVID-19 vaccination are more likely to have better outcomes, compared to those post COVID-19 infection.