COVID-19恢复患者出现心脏受累情况的比例不一，被认为是引起长期症状的潜在原因。最近COVID-19疫苗也出现了心脏并发症的报道。我们的目标是比较COVID-19后和接种疫苗后出现临床心脏症状的患者的心脏核磁共振（CMR）检查结果。从2020年5月到2021年5月，我们在一家高产量中心纳入了104例COVID-19后疑似心脏受累的患者，他们接受了有临床必要性的心脏核磁共振检查。首次PCR检测呈阳性到进行CMR检查的平均时间为112 ± 76天。在COVID-19期间，有21%的患者需要住院治疗，17%需要补充氧气，7%需要机械通气。在34例（32.7%）患者中，CMR提供了临床相关的诊断：孤立性心包炎10例（9.6%），急性心肌炎（同时为LLC）7例（6.7%），可能心肌炎（一例LLC）5例（4.8%），缺血4例（3.8%），近期梗死2例（1.9%），既往性梗死4例（3.8%），扩张型心肌病3例（2.9%），肥厚型心肌病2例（1.9%），主动脉狭窄、胸膜肿瘤和二尖瓣脱垂各1例（1.0%）。在2021年5月至2021年8月期间，我们又检查了27例接种COVID-19疫苗后出现心脏疾病症状的患者。其中，CMR提供了至少一项诊断结果的患者有22例（81.5%）：孤立性心包炎4例（14.8%），急性心肌炎9例（33.3%），可能心肌炎（急性或消退期）6例（22.2%），缺血3例（8例应激测试患者中37.5%），孤立性心包积液（>10mm）和非紧密型心肌病各1例（3.7%）。COVID-19后的心肌炎诊断数量高度依赖于所采用的心肌炎诊断标准的严格性。当仅包括水肿和LGE匹配的病例，并排除右心室插入位置的结果时，病例数量从7例减少到2例，而COVID-19疫苗后的病例数量仍旧保持在9例。虽然COVID-19疫苗后的心肌炎是一种整体上罕见的副作用，但由于过去数月接种的疫苗数量很大，它目前是我们机构中心肌炎的主要原因。与疫苗接种后的心肌炎相反，COVID-19后的心肌炎中LGE和水肿通常不匹配或仅限于右室插入位置。这些病例是否真正代表心肌炎还是另一种病理实体，需要进一步研究来确定。© 2022. 作者。

Cardiac involvement has been described in varying proportions of patients recovered from COVID-19 and proposed as a potential cause of prolonged symptoms, often described as post-COVID or long COVID syndrome. Recently, cardiac complications have been reported from COVID-19 vaccines as well. We aimed to compare CMR-findings in patients with clinical cardiac symptoms after COVID-19 and after vaccination. From May 2020 to May 2021, we included 104 patients with suspected cardiac involvement after COVID-19 who received a clinically indicated cardiac magnetic resonance (CMR) examination at a high-volume center. The mean time from first positive PCR to CMR was 112  ± 76 days. During their COVID-19 disease, 21% of patients required hospitalization, 17% supplemental oxygen and 7% mechanical ventilation. In 34 (32.7%) of patients, CMR provided a clinically relevant diagnosis: Isolated pericarditis in 10 (9.6%), %), acute myocarditis (both LLC) in 7 (6.7%), possible myocarditis (one LLC) in 5 (4.8%), ischemia in 4 (3.8%), recent infarction in 2 (1.9%), old infarction in 4 (3.8%), dilated cardiomyopathy in 3 (2.9%), hypertrophic cardiomyopathy in 2 (1.9%), aortic stenosis, pleural tumor and mitral valve prolapse each in 1 (1.0%). Between May 2021 and August 2021, we examined an additional 27 patients with suspected cardiac disease after COVID-19 vaccination. Of these, CMR provided at least one diagnosis in 22 (81.5%): Isolated pericarditis in 4 (14.8%), acute myocarditis in 9 (33.3%), possible myocarditis (acute or subsided) in 6 (22.2%), ischemia in 3 (37.5% out of 8 patients with stress test), isolated pericardial effusion (> 10 mm) and non-compaction-cardiomyopathy each in 1 (3.7%). The number of myocarditis diagnoses after COVID-19 was highly dependent on the stringency of the myocarditis criteria applied. When including only cases of matching edema and LGE and excluding findings in the right ventricular insertion site, the number of cases dropped from 7 to 2 while the number of cases after COVID-19 vaccination remained unchanged at 9. While myocarditis is an overall rare side effect after COVID-19 vaccination, it is currently the leading cause of myocarditis in our institution due to the large number of vaccinations applied over the last months. Contrary to myocarditis after vaccination, LGE and edema in myocarditis after COVID-19 often did not match or were confined to the RV-insertion site. Whether these cases truly represent myocarditis or a different pathological entity is to be determined in further studies.© 2022. The Author(s).