Myocarditis Post Vaccination or Multi System Inflammatory Syndrome

Study Overview
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Brief Summary
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BNT162b2 vaccine has become one of the most prevalent vaccines against the COVID-19 and is currently the main vaccine used in Israel. Since marketing and the beginning of use of the vaccine, we and others have reported. of the development of post vaccination myocarditis. In this study the investigators wish to explore the long term impact on 150 patients who have been diagnosed with myocarditis or multisystem inflammatory syndrome (MIS) in the year following their diagnosis of Myocarditis.

Detailed Description
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Aim of Study The primary aim of the study is to evaluate the impact of long term impact of myocarditis which has been developed secondary to Covid 19 vaccine or Covid 19 infection. The primary end points of the study will be functional evaluations of the patients using clinical evaluation that includes questionnaires, ECG findings, evaluation of the systolic and diastolic function of the heart using echocardiogram or cardiac MRI, laboratory tests including troponin, CPK, CRP, Pro-BNP, and cytokines/chemokines. Methods In this prospective study patients will be recruited from health care providers The selected patients will come to Hadassah hospital within 6 and 12 months after they have been diagnosed with myocarditis. Upon the patients arrival they will sign the informed consent, the investigators will draw blood tests and the participants will perform an echocardiogram according to the special protocol and will perform cardiac- MRI according to the myocarditis protocol. Patients will fulfill health questionnaires. that may include 36 Health Survey Questionnaire (SF-36); Scores on the European Quality of Life-5 Dimensions (EQ-5D) survey, which is also health-related quality of life score; the Scores on the European Quality of Life Visual Analogue Scale (EQ-VAS); Kansas City Cardiomyopathy Questionnaire (KCCQ). the Investigators will obtain blood samples from all the patients: complete blood count, c- reactive protein, troponin, CPK, Pro-BNP, liver and kidney functions, magnesium and cytokines. In addition, all participants will undergo echocardiogram test to evaluate their systolic and diastolic function of the heart. Ethical Considerations The study poses no danger to the participants. It has the potential to improve the understanding of the impact myocarditis post COVID-19 MRNA vaccine on the quality of life of those patients and provide a descent follow-up for the participant. Any participant will sign on informed consent form.

Official Title
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Consequences of Post BNT162b2 Vaccine Myocarditis and Multiple Inflammatory Syndrome Myocarditis

Conditions
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Myocarditis

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult males and females. Minors male and female. Diagnosed as myocarditis: Evidence of myocarditis on biopsy or increased biomarkers of myocardial injury (TNI and CK-MB and BNP or NT-pro-BNP) Acute onset of symptoms of cardiac dysfunction: dyspnea, palpation, chest pain, and/or syncope; Image for cardiac injury: marked diffused reduction in left ventricle wall movement, with dramatically decreased left ventricle ejection fraction (LVEF) < 45%, or by cardiac magnetic resonance imaging. Exclusion Criteria: Also considering acute coronary syndrome but unable to perform coronary angiography to distinguish acute coronary syndrome from myocarditis, or otherwise suffer from valvuloplasty. Myocardial injury caused by sepsis, medical agents, or poisons; Malignancy or any comorbidity limiting survival or conditions predicting inability to complete the study

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| participant post first BNT162b2 vaccination<br>Patients which developed myocarditis after the first dose of BNT162b2 vaccination | Other: No intervention<br>* This is an observational study, with no intervention.<br>|
| participant post second BNT162b2 vaccination<br>Patients which developed myocarditis after the second dose of BNT162b2 vaccination | Other: No intervention<br>* This is an observational study, with no intervention.<br>|
| participant post third BNT162b2 vaccination<br>Patients which developed myocarditis after the third dose of BNT162b2 vaccination diagnosed with MIS | Other: No intervention<br>* This is an observational study, with no intervention.<br>|
| participant post COVID-19<br>Patients which developed myocarditis after COVID-19 infection | Other: No intervention<br>* This is an observational study, with no intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To assess troponin levels in patients that developed acute myocarditis | troponin levels in each clinical visit will be documented | 3 years | 
| To assess PRO-BNP levels in patients that developed acute myocarditis | PRO-BNP levels in each clinical visit will be documented | 3 years | 
| To assess CRP levels in patients that developed acute myocarditis | CRP levels in each clinical visit will be documented | 3 years | 
| To assess cardiac MRI in patients that developed acute myocarditis | Cardiac MRI will be performed at least yearly and evaluated for regionally increased signal in T2-weighted images; Late gadolinium enhancement in a nonischemic pattern, Increased native T1 values on a 3T magnet. | 3 years | 
| To assess echocardiogram in patients that developed acute myocarditis | echocardiogram will be performed at least yearly and defined as normal, ST-segment elevation, with Diffuse or Non-diffuse changes, T-wave changes, Atrial fibrillation or non-sustained ventricular tachycardia. | 3 years | 
| To assess health quality by a questionnaire in patients that developed acute myocarditis | EQ-5D will be fill at least once a year. Descriptive analysis of EQ-5D profile at each observation and analysis of changes between repeated observations. Cluster analysis can be used. | 3 years | 
| To assess heart failure questionnaire in patients that developed acute myocarditis | KCCQ will be fill at least once a year. | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cytokine in Patients after myocarditis | To assess cytokines by measuring the serum concentrations | 3 years | 
| Chemokine in Patients after myocarditis | To assess chemokines by measuring the serum concentrations | 3 years | 
| Hematopoietic Growth Factors (HGF)in patients after myocarditis | To assess Hematopoietic Growth Factors in patients with COVID-19 by measuring the To assess HGF by measuring the serum concentrations | 3 years | 
| Complement in patients after myocarditis | assess complement factors by measuring the serum concentrations | 3 years |