Heart Failure With Severely Reduced Ejection Fraction Following Covid-19 Vaccine: A Case Series

INTRODUCTION: With the rise of the pandemic, the development of the COVID-19 vaccine has helped alleviate the burden on the healthcare system. However, rare cardiac side effects have been reported, especially within the young healthy population. Herein, we present a case series of four patients who received the Pfizer mRNA COVID-19 vaccine and were noted to have heart failure with severely reduced ejection fraction (≤ 25%) a few weeks following the 2(nd) dose of the Pfizer vaccine. METHODS: This is a retrospective study from January 2021 to August 2021. Patient cases were identified from hospitalizations or clinic visits. Each case was evaluated for underlying predisposing conditions, vaccination type, symptoms onset, diagnostic studies, and outcomes. RESULTS: A total of four patients were identified (table). Patients’ ages ranged from 22-43 years old. Seventy-five percent of the patient population were male. All patients commonly reported clinical symptoms of heart failure including fatigue, orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema starting within three weeks from receiving the second dose of the Pfizer COVID-19 Vaccine. Patients had no prior known cardiac history or predisposing conditions. Diagnostic workup including a left heart catheterization showed normal coronaries. Echocardiograms showed significantly reduced left ventricular ejection fraction (LVEF) ≤ 25%. Three patients were confirmed to have non-inflammatory cardiomyopathy via endomyocardial biopsy or cardiac MRI. One patient was unable to get a cardiac MRI due to a concomitant acute renal injury. Patients were started on Guideline-directed medical therapy (GDMT). Two patients were noted to have an improvement in their ejection fraction with one patient achieving full recovery to LVEF of 62%. One patient is currently undergoing evaluation for advanced heart failure therapy while the last patient has relocated. CONCLUSION: s The relationship between the novel mRNA COVID-19 vaccine and cardiomyopathy remains to be an area in need of further investigation. Despite the unclear mechanism, management remains to be with GDMT and advanced therapies as indicated. EF recovery and improved clinical outcomes can be achieved in some.