Research background
Myocardial injury/myocarditis
Serious adverse events may occur after receiving the mRNA COVID-19 vaccine, and they mainly occur in young men, often occur a few days after vaccination. Although passive monitoring results show that myocardial injury/myocarditis occurs after BNT162b2-mRNA (Pfizer-biontech) or mRNA-1273 (Moderna) is rare, since passive monitoring can only find severe cases requiring hospitalization, the incidence of mild myocardial injury/myocarditis may be severely underestimated.
study hypothesized that
is actually more common because the symptoms may be mild and inspecific, or even asymptomatic, and myocardial injury related to vaccines is actually more common. Therefore, it is of great significance to evaluate the true incidence. Given that the protection effect gradually weakens after months of COVID-19 vaccination, billions of people around the world may need repeated vaccination and strengthening of vaccines, patients, physicians and public health authorities need this information to make informed decisions.
Research Purpose
This study has two main purposes. The first is to evaluate the real incidence of myocardial injury/myocarditis after vaccination with COVID-19 mRNA vaccine. The second is to provide a "safety net" for people who are determined to have vaccine-related myocardial injury so that early detection and preventive measures can be taken to avoid aggravation.
Research Methods
employees who were included in the Swiss University Hospital of Basel, Switzerland who planned to receive the mRNA-1273 enhancement vaccine. The exclusion criteria are those who have a history of cardiac events or cardiac surgery 30 days before vaccination. The main endpoint event was: ruling as acute myocardial injury ULN (myocarditis), with no evidence of other causes. The secondary endpoint events were: a) acute cardiomyocyte injury. b) Major adverse cardiac events (MACEs) in 30d: cardiac death, acute heart failure, fatal arrhythmia, acute myocardial infarction . (See Figure 1)
Figure 1
Research results
recruited 835 patients from December 2021 to February 2022, 58 patients were excluded, and 777 patients were finally enrolled. According to the hs-cTnT level, they were divided into two groups. Finally, 22 patients were ruled as acute myocardial injury (see Figure 2 for the basic status of the patients). The incidence of myocardial injury was 2.8% [95%CI: 1.7 ~ 4.3%] (Figure 3).
Figure 2
Figure 3
Women have a higher risk of acute myocardial injury than men (Figures 4 and 5).
Figure 4
Figure 5
discussion
First of all, the study found that the incidence of myocardial injury/myocarditis after inoculation with the COVID-19 mRNA vaccine was 2.8%. However, the symptoms are mild and no MACE events occur within 30 days of vaccination. However, the long-term risks of myocardial injury related to mRNA vaccine on arrhythmia and heart failure are not clear, and further research is still needed. Small-scale acute myocardial injury (1/4 of spontaneous myocarditis) suggest a good long-term prognosis.
Research limitations
First, since the blood test time is only fixed on the third day after vaccination, the real incidence may be underestimated. Secondly, CMR testing is lacking. Third, this study has not yet clarified the mechanism of cardiomyocyte injury and the extent of impact of early detection and treatment on prognosis. Finally, the study did not evaluate the incidence of vaccine-induced pericarditis .
Research Conclusion
Through active monitoring, myocardial injury related to mRNA-1273 vaccine (may suggest myocarditis) is much more common than previously thought. One out of every 35 people had mild cases and the incidence rate was higher in women than in men.
Expert comments
As early as February 2020, National Geriatric Medical Center issued the "Expert Suggestions on Clinical Management of Myocardial Injuries Related to the New Coronavirus Pneumonia", pointing out that COVID-19-related myocardial injury refers to the level of myocardial injury marker in confirmed or suspected patients with COVID-19, and there is no clinical evidence of myocardial ischemia , and it may be accompanied by increased BNP or NT-proBNP levels. Although the mechanisms of heart damage caused by COVID-19 are unclear, it is certain that a certain proportion of myocardial injury exists in COVID-19 patients.
American Society of Cardiology (ACC) has released decision-making paths for the diagnosis and management of myocarditis, myocardial involvement and cardiac sequelae after infection with the new coronavirus. The author points out that myocarditis is considered a rare but serious complication of coronavirus infection and mRNA vaccination. Previous studies have suggested that the risk of myocarditis related to different vaccinations is far lower than the risk of myocarditis after the new coronavirus infection. The U.S. Centers for Disease Control and Prevention (CDC) mentioned that more and more reports of myocarditis and pericarditis have been received in adolescents and young people after receiving the new crown vaccine , but at present, "the known and potential benefits of new crown vaccine vaccination outweigh the known and potential risks." The current study found through active monitoring that myocardial injury associated with mRNA-1273 vaccine (which may suggest myocarditis) is much more common than previously thought, but most of the conditions are mild.
The current link between myocarditis and vaccination still needs more research evidence. The mechanism of mRNA causing cardiac damage is unclear. Moreover, the link between myocarditis and vaccination is likely to be quite different between different vaccines. But overall, the benefits of vaccination are far greater than the risks.
Expert Profile
Wang Fang Professor
PhD, chief physician, doctoral supervisor. Director of the Department of Cardiology of Beijing Hospital. He has been engaged in clinical medical care for 35 years, and is good at drug treatment and clinical evaluation of diseases such as coronary heart disease , hypertension , hyperlipidemia, heart failure, arrhythmia, etc., and has rich clinical experience in diagnosing cardiovascular diseases with echocardiography.
President of the Cardiovascular Health and Science Sports Branch of the China Medical and Health Culture Association; Deputy Chairman of the Cardiology and Vascular Committee of the China Female Physicians Association; Director-General of the Electrocardiogram and Cardiac Function Branch of the China Geriatric Society; Chairman of the Drug Clinical Trial Research Standard Evaluation Branch of the China Medical Education Association; Deputy Chairman of the Intelligent Lifestyle Medicine Professional Committee of the China Geriatric Health Association;
Member of the Cardiovascular Imaging Group of the Cardiovascular Branch of the Chinese Medical Association; Standing Committee member of the China Heart Failure Alliance; Standing Committee member of the Cardiovascular Disease Prevention and Treatment Branch of the China Medical Care International Exchange Promotion Association, member of the Cardiovascular Physicians Branch of the Chinese Medical Association, Standing Committee member of the China Medical Imaging Technology Research Association, Standing Committee member of the Echocardiography Working Committee of the Chinese Medical Association;
Deputy Chairman of the Expert Committee of the Chronic Disease Prevention and Control Working Committee of the China Anti-Aging Promotion Association, Standing Committee member of the Expert Committee of the Chronic Disease Prevention and Control Working Committee of the Chinese Association for Gerontology and Geriatric Medicine, Standing Committee member of the Cardiovascular Disease Prevention and Micro-Popular Science Experts of the Fourth Batch of Sunshine Great Wall Chronic Disease Prevention Weibo Science Popularization Experts, etc. Member of the National Health Science Popularization Expert Database; serves as the Communication Editor of the 10th Editorial Committee of the " Chinese Journal of Cardiovascular Diseases ", and is an editor of the Journal of China Medical Imaging , China General Medicine and other journals.
Statement: This article is for reference only for medical and health professionals to understand the latest medical information and does not represent the views of this platform. This information cannot replace professional medical guidance in any way, nor should it be regarded as a medical advice. If the information is used for purposes other than information, this website and the author shall not bear relevant responsibilities.
