{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:36:07Z","timestamp":1790883367197,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T00:00:00Z","timestamp":1655856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"INVESTITIONSBANK BERLIN (IBB)","award":["10169096"],"award-info":[{"award-number":["10169096"]}]},{"name":"INVESTITIONSBANK BERLIN (IBB)","award":["10169098"],"award-info":[{"award-number":["10169098"]}]},{"name":"INVESTITIONSBANK BERLIN (IBB)","award":["10169028"],"award-info":[{"award-number":["10169028"]}]},{"name":"European Regional Development Fund (EFRE)","award":["10169096"],"award-info":[{"award-number":["10169096"]}]},{"name":"European Regional Development Fund (EFRE)","award":["10169098"],"award-info":[{"award-number":["10169098"]}]},{"name":"European Regional Development Fund (EFRE)","award":["10169028"],"award-info":[{"award-number":["10169028"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Myocarditis in response to COVID-19 vaccination has been reported since early 2021. In particular, young male individuals have been identified to exhibit an increased risk of myocardial inflammation following the administration of mRNA-based vaccines. Even though the first epidemiological analyses and numerous case reports investigated potential relationships, endomyocardial biopsy (EMB)-proven cases are limited. Here, we present a comprehensive histopathological analysis of EMBs from 15 patients with reduced ejection fraction (LVEF = 30 (14\u201339)%) and the clinical suspicion of myocarditis following vaccination with Comirnaty\u00ae (Pfizer-BioNTech) (n = 11), Vaxzevria\u00ae (AstraZenica) (n = 2) and Janssen\u00ae (Johnson &amp; Johnson) (n = 2). Immunohistochemical EMB analyses reveal myocardial inflammation in 14 of 15 patients, with the histopathological diagnosis of active myocarditis according the Dallas criteria (n = 2), severe giant cell myocarditis (n = 2) and inflammatory cardiomyopathy (n = 10). Importantly, infectious causes have been excluded in all patients. The SARS-CoV-2 spike protein has been detected sparsely on cardiomyocytes of nine patients, and differential analysis of inflammatory markers such as CD4+ and CD8+ T cells suggests that the inflammatory response triggered by the vaccine may be of autoimmunological origin. Although a definitive causal relationship between COVID-19 vaccination and the occurrence of myocardial inflammation cannot be demonstrated in this study, data suggest a temporal connection. The expression of SARS-CoV-2 spike protein within the heart and the dominance of CD4+ lymphocytic infiltrates indicate an autoimmunological response to the vaccination.<\/jats:p>","DOI":"10.3390\/ijms23136940","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T21:31:06Z","timestamp":1655933466000},"page":"6940","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Intramyocardial Inflammation after COVID-19 Vaccination: An Endomyocardial Biopsy-Proven Case Series"],"prefix":"10.3390","volume":"23","author":[{"given":"Christian","family":"Baumeier","sequence":"first","affiliation":[{"name":"Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganna","family":"Aleshcheva","sequence":"additional","affiliation":[{"name":"Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Harms","sequence":"additional","affiliation":[{"name":"Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Gross","sequence":"additional","affiliation":[{"name":"Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hamm","sequence":"additional","affiliation":[{"name":"Kerckhoff Heart Center, Department of Cardiology, 61231 Bad Nauheim, Germany"},{"name":"Department of Cardiology and Angiology, Universit\u00e4tsklinikum Gie\u00dfen und Marburg, 35391 Gie\u00dfen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2658-6444","authenticated-orcid":false,"given":"Birgit","family":"Assmus","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Universit\u00e4tsklinikum Gie\u00dfen und Marburg, 35391 Gie\u00dfen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Westenfeld","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University D\u00fcsseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Kelm","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University D\u00fcsseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4813-5580","authenticated-orcid":false,"given":"Spyros","family":"Rammos","sequence":"additional","affiliation":[{"name":"Onassis Cardiac Surgery Center, 176 74 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5397-2781","authenticated-orcid":false,"given":"Philip","family":"Wenzel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5503-4150","authenticated-orcid":false,"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albrecht","family":"Els\u00e4sser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Klinikum Oldenburg, 26133 Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mudather","family":"Gailani","sequence":"additional","affiliation":[{"name":"Frankenwaldklinik, 96317 Kronach, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Perings","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Marien-Hospital, 44534 L\u00fcnen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alae","family":"Bourakkadi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cardiology, Geriatrics and Palliative Medicine, Gemeinschaftsklinikum Mittelrhein gGmbH, 56727 Mayen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Flesch","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Marienkrankenhaus gGmbH, 59494 Soest, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tibor","family":"Kempf","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Bauersachs","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0678-5681","authenticated-orcid":false,"given":"Felicitas","family":"Escher","sequence":"additional","affiliation":[{"name":"Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany"},{"name":"Department of Cardiology, Campus Virchow-Klinikum, Charit\u00e9 University Medicine Berlin, 13353 Berlin, Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz-Peter","family":"Schultheiss","sequence":"additional","affiliation":[{"name":"Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,22]]},"reference":[{"key":"ref_1","unstructured":"CDC Centers for Disease Control and Prevention (2022, April 06). 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