The overall goal of the study is to investigate the characteristics and potential mechanisms responsible for myocardial injury and dysfunction in patients after COVID-19 vaccination. Cardiac damage will be assessed with cardiac MRI and endomyocardial biopsy (EmBx) histopathology. Myocardial gene expression will be measured in RNA extracted from EmBxs mRNA abundance compared to nonfailing and failing control hearts.
To determine whether there is microvascular thrombosis-associated myocardial damage and
dysfunction vs. inflammation or other changes in patients who, following administration of
SARS-CoV-2 mRNA vaccine, develop evidence of myocardial injury typically diagnosed as
"myocarditis" based on cardiac MRI findings.
Further, the degree of inflammatory reaction vs. microthrombotic injury to cardiac myocytes
from biopsied myocardial tissue will be compared with biopsied myocardial tissue from control
hearts. mRNA expression of the ACE2 and ITGA5 binding targets of SARS-Cov-2 Spike protein
encoded by mRNA vaccines, as well as expression of other genes that may contribute to
post-vaccine pro-thrombotic and pro-inflammatory states including Coagulation Factor 3 (F3,
also known as tissue factor), ACE, AGTR1 and AGT) or a dysfunctional cardiac state (NPPB as a
marker of pathologic remodeling) will be examined as candidate genes. Additional, global gene
expression is being measured by RNA-Seq and microarray.
Inclusion Criteria:
1. age ≥18 years;
2. clear evidence of myocardial involvement including:
1. High Sensitivity Troponin I value of (≥0.05 ng/ml (the 99% upper bound)) OR
2. an LVEF < 50% OR
3. ST-T change suggesting STEMI, NSTEMI or myopericarditis in the absence of
coronary artery disease, OR
4. new onset sustained VT or VF
3. Late gadolinium enhancement or edema on cMRI consistent with myocardial injury or
inflammation.
4. Documentation of vaccination with mRNA-based COVID-19 vaccine.
5. No history of COVID-19, or a negative SARS-CoV-2 PCR or other FDA approved laboratory
test within 1 week of enrollment.
6. Patient and/or legally authorized representative must be competent to understand and
agree with informed consent form.
Exclusion Criteria:
1. Hemodynamic instability as evidenced by escalating doses of inotropic agents or
vasopressors within the prior 24 hours
2. Respiratory instability as evidenced by increasing oxygen requirements over the 24
hours prior to consent or FiO2 requirement ≥ 60 %.
3. evidence that respiratory failure is the primary reason for myocardial dysfunction;
4. Moderate to severe pulmonary hypertension (mean PAP ≥35 mmHg);
5. INR >1.8 on no anticoagulation or contraindication to withdrawing anticoagulation;
6. platelets <100,000/mm3.
7. History of laboratory-confirmed SARS-CoV-2 infection as determined by polymerase chain
reaction (PCR) testing or other commercial or public health assay.
8. Acute or chronic kidney disease with glomerular filtration rate < 30 ml/min.1.72m2
University of Colorado Anschutz Medical Campus
Aurora, Colorado, United States
Investigator: Natasha Altman, MD
Contact: 303-724-4544
Natasha.Altman@cuanschutz.edu
Rachel Rosenberg, MS
303 724 4544
Rachel.Rosenberg@cuanschutz.edu
Natasha Altman, MD
303 724 4544
Natasha.Altman@cuanschutz.edu