Assessing the Risk of Myocarditis Post-COVID-19 Vaccination: A Systematic Review of Case Reports from 2023 to 2025.

COVID-19 vaccines covered a crucial role in mitigating the pandemic; however, rare adverse events such as myocarditis continue to raise safety concerns. This systematic review evaluated whether the clinical profile and outcomes of COVID-19 vaccine–associated myocarditis (CVAM) have changed in the post-2022 era. Following PRISMA guidelines, case reports published between 2023 and 2025 were identified through Web of Science, Embase, and PubMed (MEDLINE). Twenty-eight articles describing 35 patients were included. CVAM predominantly affected males, with the highest frequency among adolescents aged 10–19 years, and most cases occurred after the second vaccine dose, typically within two weeks. Chest pain was the most common presenting symptom, followed by tachycardia, fever, and dyspnea. Elevated cardiac biomarkers, electrocardiographic abnormalities, and myocardial edema on cardiac magnetic resonance imaging were frequently observed, with reduced left ventricular ejection fraction in a subset of patients. Management ranged from nonsteroidal anti-inflammatory drugs and colchicine to immunosuppressive therapy and mechanical circulatory support in severe cases. Although many patients experienced clinical improvement, fatal cases were documented, and follow-up revealed persistent late gadolinium enhancement and recurrent arrhythmias in several individuals, indicating incomplete myocardial recovery. Unlike earlier reviews reporting largely mild and self-limiting disease, this 2023–2025 case series documents fatal outcomes, persistent myocardial fibrosis, and recurrent arrhythmias, suggesting that CVAM may lead to long-term cardiac sequelae in a subset of patient. These findings indicate that contemporary clinical spectrum of CVAM may be broader and more severe than previously recognized, underscoring the need for prolonged surveillance and updated management strategies.