T2 mapping should be utilized in cases of suspected myocarditis to confirm an acute inflammatory process.

Abstract

Dear Editor, I read with interest the case series by Kiozumi et al.,1 which describes two cases of vaccine-induced myocarditis. The second case describes a 27-year-old male who presents 3 days after receiving a second dose of the mRNA-1273 coronavirus disease 2019 (Moderna) vaccine with chest pain, inferior ST-elevation on a resting 12-lead electrocardiogram and an elevated serum troponin-T. An invasive coronary angiogram revealed no coronary artery lesions and an endomyocardial biopsy was unremarkable. Cardiac magnetic resonance (CMR) imaging demonstrated inferolateral epicardial late gadolinium enhancement, along with elevated native T1 and extracellular volume measurements and in the inferolateral wall. Although the symptomatology, electrocardiogram changes and elevated cardiac enzymes are all consistent with active myocarditis; the CMR imaging findings described are not confirmatory of an acute inflammatory process. The elevated native T1, extracellular volume measurements and late gadolinium enhancement could be consistent with a previous myocardial insult and represent a chronic fibrotic process/myocardial scar. This hypothesis is supported by the unremarkable myocardial biopsy, which failed to demonstrate any active inflammation.