Clinical Manifestations and Adverse Cardiovascular Events in Patients with Cardiovascular Symptoms after mRNA Coronavirus Disease 2019 Vaccines
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Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines(mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion: Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.
Abstract
Purpose: The number of patients presenting with vaccination-related cardiovascular symptoms after receiving mRNA vaccines(mRNA-VRCS) is increasing. We investigated the incidence of vaccine-related adverse events (VAEs), including myocarditis and pericarditis, in patients with mRNA-VRCS after receiving BNT162b2-Pfizer-BioNTech and mRNA-1273-Moderna vaccines. Materials and Methods: We retrospectively collected data on patients presenting with mRNA-VRCS who visited the outpatient clinic of two tertiary medical centers. Clinical characteristics, laboratory findings, echocardiographic findings, and electrocardiographic findings were evaluated. VAE was defined as myocarditis or pericarditis in patients after mRNA vaccination. Clinical outcomes during short-term follow-up, including emergency room (ER) visit, hospitalization, or death, were also assessed among the patients. Results: A total of 952 patients presenting with mRNA-VRCS were included in this study, with 89.7% receiving Pfizer-BioNTech and 10.3% receiving Moderna vaccines. The mean duration from vaccination to symptom was 5.6±7.5 days. VAEs, including acute myocarditis and acute pericarditis, were confirmed in 11 (1.2%) and 10 (1.1%) patients, respectively. The VAE group showed higher rates of dyspnea, echocardiography changes, and ST-T segment changes. During the short-term follow-up period of 3 months, the VAE group showed a higher hospitalization rate compared to the control group; there was no significant difference in ER visit (p=0.320) or mortality rates (p>0.999). Conclusion: Amongst the patients who experienced mRNA-VRCS, the total incidence of VAEs, including acute myocarditis and pericarditis, was 2.2%. Patients with VAEs showed higher rates of dyspnea, echocardiographic changes, and ST-T segment changes compared to those without VAEs. With or without the cardiovascular events, the prognosis in patients with mRNA-VRCS was favorable.
참고문헌 (21)
- "Coronavirus disease 2019 (COVID-19) vaccines"[URL]
- Montgomery J, "Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military", JAMA Cardiol, 6, pp.1202~1206 (2021)
- Halsell JS, "Myopericarditis following smallpox vaccination among vaccinia-naive US military personnel", JAMA, 289, pp.3283~3289 (2003)
- Kim YJ, "Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation", Acute Crit Care, 34, pp.165~169 (2019)
- Mevorach D, "Myocarditis after BNT162b2 mRNA vaccine against COVID-19in Israel", N Engl J Med, 385, pp.2140~2149 (2021)
- "Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 7-10 June 2021"[URL]
- Gargano JW, "Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients : update from the Advisory Committee on Immunization Practices-United States, June 2021", MMWR Morb Mortal Wkly Rep, 70, pp.977~982 (2021)
- Kim HW, "Patients with acute myocarditis following mRNA COVID-19 vaccination", JAMA Cardiol, 6, pp.1196~1201 (2021)
- Muthukumar A, "In-depth evaluation of a case of presumed myocarditis after the second dose of COVID-19 mRNA vaccine", Circulation, 144, pp.487~498 (2021)
- D’Angelo T, "Myocarditis after SARS-CoV-2 vaccination : a vaccine-induced reaction?", Can J Cardiol, 37, pp.1665~1667 (2021)
- Caforio AL, "Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis : a position statement of the European Society of Cardiology working group on myocardial and pericardial diseases", Eur Heart J, 34, pp.2636~2648 (2013)
- Truong DT, "Clinically suspected myocarditis temporally related to COVID-19 vaccination in adolescents and young adults : suspected myocarditis after COVID-19 vaccination", Circulation, 145, pp.345~356 (2022)
- Cho JY, "COVID-19vaccination-related myocarditis : a Korean nationwide study", Eur Heart J, 44, pp.2234~2243 (2023)
- Bozkurt B, "Myocarditis with COVID-19 mRNA vaccines", Circulation, 144, pp.471~484 (2021)
- Oh TH, "Clinical features of patients presenting to the emergency department with cardiovascular adverse reactions after COVID-19 mRNA vaccination", J Korean Med Sci, 37, pp.e73~ (2022)
- Hyun J, "Reactogenicity and immunogenicity of the ChAdOx1 nCOV-19 coronavirus disease 2019 vaccine in South Korean healthcare workers", Yonsei Med J, 63, pp.1078~1087 (2022)
- Im JH, "Adverse events with the Pfizer-BioNTech COVID-19 vaccine among Korean healthcare workers", Yonsei Med J, 62, pp.1162~1168 (2021)
- Zimmermann P, "Factors that influence the immune response to vaccination", Clin Microbiol Rev, 32, pp.e00084-18~ (2019)
- Patone M, "Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2infection", Nat Med, 28, pp.410~422 (2022)
- Simadibrata DM, "Neutrophilto-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients : a meta-analysis", Am J Emerg Med, 42, pp.60~69 (2021)
- Sonaglioni A, "Charlson comorbidity index, neutrophil-to-lymphocyte ratio and undertreatment with renin-angiotensin-aldosterone system inhibitors predict in-hospital mortality of hospitalized COVID-19 patients during the omicron dominant period", Front Immunol, 13, pp.958418~ (2022)