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Korzun T, Moses AS, Jozic A, Grigoriev V, Newton S, Kim J, Diba P, Sattler A, Levasseur PR, Le N, Singh P, Sharma KS, Goo YT, Mamnoon B, Raitmayr C, Mesquita Souza AP, Taratula OR, Sahay G, Taratula O, Marks DL. Lipid Nanoparticles Elicit Reactogenicity and Sickness Behavior in Mice Via Toll-Like Receptor 4 and Myeloid Differentiation Protein 88 Axis. ACS NANO 2024; 18:24842-24859. [PMID: 39186628 DOI: 10.1021/acsnano.4c05088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
mRNA therapeutics encapsulated in lipid nanoparticles (LNPs) offer promising avenues for treating various diseases. While mRNA vaccines anticipate immunogenicity, the associated reactogenicity of mRNA-loaded LNPs poses significant challenges, especially in protein replacement therapies requiring multiple administrations, leading to adverse effects and suboptimal therapeutic outcomes. Historically, research has primarily focused on the reactogenicity of mRNA cargo, leaving the role of LNPs understudied in this context. Adjuvanticity and pro-inflammatory characteristics of LNPs, originating at least in part from ionizable lipids, may induce inflammation, activate toll-like receptors (TLRs), and impact mRNA translation. Knowledge gaps remain in understanding LNP-induced TLR activation and its impact on induction of animal sickness behavior. We hypothesized that ionizable lipids in LNPs, structurally resembling lipid A from lipopolysaccharide, could activate TLR4 signaling via MyD88 and TRIF adaptors, thereby propagating LNP-associated reactogenicity. Our comprehensive investigation utilizing gene ablation studies and pharmacological receptor manipulation proves that TLR4 activation by LNPs triggers distinct physiologically meaningful responses in mice. We show that TLR4 and MyD88 are essential for reactogenic signal initiation, pro-inflammatory gene expression, and physiological outcomes like food intake and body weight─robust metrics of sickness behavior in mice. The application of the TLR4 inhibitor TAK-242 effectively reduces the reactogenicity associated with LNPs by mitigating TLR4-driven inflammatory responses. Our findings elucidate the critical role of the TLR4-MyD88 axis in LNP-induced reactogenicity, providing a mechanistic framework for developing safer mRNA therapeutics and offering a strategy to mitigate adverse effects through targeted inhibition of this pathway.
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Affiliation(s)
- Tetiana Korzun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, Oregon 97239, United States
- Medical Scientist Training Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
| | - Abraham S Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Antony Jozic
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Vladislav Grigoriev
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Samuel Newton
- Papé Family Pediatric Research Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code L481, Portland, Oregon 97239, United States
| | - Jeonghwan Kim
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Parham Diba
- Medical Scientist Training Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
- Papé Family Pediatric Research Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code L481, Portland, Oregon 97239, United States
| | - Ariana Sattler
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, 2720 S Moody Avenue, Portland, Oregon 97201, United States
| | - Peter R Levasseur
- Papé Family Pediatric Research Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code L481, Portland, Oregon 97239, United States
| | - Ngoc Le
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Prem Singh
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Kongbrailatpam Shitaljit Sharma
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Yoon Tae Goo
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Babak Mamnoon
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Constanze Raitmayr
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Ana Paula Mesquita Souza
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Olena R Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, Oregon 97239, United States
| | - Gaurav Sahay
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, Oregon 97201, United States
| | - Daniel L Marks
- Endevica Bio, 1935 Techny Rd, Northbrook, Illinois 60062, United States
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Pham-Huy A, Bowes J, Russell K, Amira A, Lai L. Short- and long-term outcomes of cardiac adverse events following COVID-19 immunization managed in a Canadian pediatric center. Vaccine 2024:S0264-410X(24)00731-X. [PMID: 39003104 DOI: 10.1016/j.vaccine.2024.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/04/2024] [Accepted: 06/25/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Numerous reports have described the clinical presentation of cardiac adverse events following immunization (AEFI) with COVID-19 vaccines but long-term outcome studies are limited, especially in the pediatric population. METHODS This is a single center retrospective case series of pediatric patients with cardiac AEFI following the Pfizer/BioNTech mRNA COVID-19, diagnosed between May 2021 and May 2022, and managed following a standardized protocol. Follow up information is presented up to 12 months post diagnosis. The incidence rate of cardiac AEFI was estimated for Ottawa residents. RESULTS All cases were male (N = 17) with an average age of 16 years (range = 12-17). The majority of cases occurred after the 2nd (12/17) or 3rd vaccine dose (4/17) and were manifested mostly as myopericarditis (15/17). Average interval between the 1st and 2nd vaccine (n = 12) doses was 38 days (21-69 days). All patients improved promptly on non-steroidal anti-inflammatory drugs without recurrence. Five patients reported negative impact on quality of life and mental health, including 2 cases that led to new vaccine hesitancy, not only to COVID-19 vaccine, but also to other routine vaccines. The rate of cardiac AEFI was estimated for residents of the city of Ottawa and found to be 12.01 cases (CI 90 5.98-21.68) per 100,000 doses following the 2nd dose and 16.56 cases (CI 90 5.66-37.90) per 100,000 doses following the 3rd dose for males aged 12 to 17 years. CONCLUSIONS Twelve months following the AEFI, all patients clinically recovered from their myopericarditis, but some reported negative impact on quality of life and mental health, including new vaccine hesitancy. This highlights the importance for timely and systematic evaluation of AEFI and the need to provide support, follow up and vaccine counseling in individuals experiencing an AEFI.
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Affiliation(s)
- Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, CHEO, University of Ottawa, Canada
| | | | | | - Ali Amira
- Department of Epidemiology, Ottawa Public Health, Canada
| | - Lillian Lai
- Division of Cardiology, CHEO, University of Ottawa, Canada.
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Padilla‐Flores T, Sampieri A, Vaca L. Incidence and management of the main serious adverse events reported after COVID-19 vaccination. Pharmacol Res Perspect 2024; 12:e1224. [PMID: 38864106 PMCID: PMC11167235 DOI: 10.1002/prp2.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2n first appeared in Wuhan, China in 2019. Soon after, it was declared a pandemic by the World Health Organization. The health crisis imposed by a new virus and its rapid spread worldwide prompted the fast development of vaccines. For the first time in human history, two vaccines based on recombinant genetic material technology were approved for human use. These mRNA vaccines were applied in massive immunization programs around the world, followed by other vaccines based on more traditional approaches. Even though all vaccines were tested in clinical trials prior to their general administration, serious adverse events, usually of very low incidence, were mostly identified after application of millions of doses. Establishing a direct correlation (the cause-effect paradigm) between vaccination and the appearance of adverse effects has proven challenging. This review focuses on the main adverse effects observed after vaccination, including anaphylaxis, myocarditis, vaccine-induced thrombotic thrombocytopenia, Guillain-Barré syndrome, and transverse myelitis reported in the context of COVID-19 vaccination. We highlight the symptoms, laboratory tests required for an adequate diagnosis, and briefly outline the recommended treatments for these adverse effects. The aim of this work is to increase awareness among healthcare personnel about the serious adverse events that may arise post-vaccination. Regardless of the ongoing discussion about the safety of COVID-19 vaccination, these adverse effects must be identified promptly and treated effectively to reduce the risk of complications.
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Affiliation(s)
- Teresa Padilla‐Flores
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Alicia Sampieri
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Luis Vaca
- Departamento de Biología Celular y del desarrollo, Instituto de Fisiología CelularUniversidad Nacional Autónoma de México (UNAM)Mexico CityMexico
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Li C, Li P, Peddibhotla B, Teng C, Shi A, Lu X, Cai P, Dai Q, Wang B. Takotsubo syndrome and vaccines: a systematic review. ESC Heart Fail 2024; 11:1795-1801. [PMID: 38344896 PMCID: PMC11098634 DOI: 10.1002/ehf2.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
AIMS Takotsubo syndrome (TTS) is a rare complication of vaccination. In this study, we sought to provide insight into the characteristics of reported TTS induced by vaccination. METHODS AND RESULTS We did a systematic review, searching PubMed, Embase, Web of Science, Ovid MEDLINE, Journals@Ovid, and Scopus databases up to 26 April 2023 to identify case reports or case series of vaccine-induced TTS. We then extracted and summarized the data from these reports. Eighteen reports were identified, with a total of 19 patients with TTS associated with vaccinations. Of the 19 included patients, the majority were female (n = 13, 68.4%) with a mean age of 56.6 ± 21.9 years. Seventeen patients developed TTS after coronavirus disease 2019 vaccination, 14 of whom received an mRNA vaccination. Two cases of TTS occurred after influenza vaccination. Among the 19 patients, 17 (89.5%) completed transthoracic echocardiography and 16 (84.2%) underwent angiography procedures. Seven patients (36.8%) completed cardiac magnetic resonance imaging. The median time to symptom onset was 2 (inter-quartile range, 1-4) days. The most common symptoms were chest pain (68.4%), dyspnoea (57.9%), and digestive symptoms (31.6%). A total of 57.9% of patients developed nonspecific symptoms such as fatigue, myalgia, diaphoresis, and fever. Among the 16 reported cases of TTS, 15 patients (93.8%) exhibited elevated cardiac troponin levels, while among the nine reported cases, eight patients (88.9%) had elevated natriuretic peptide levels. All patients had electrocardiographic changes: ST-segment change (47.1%), T-wave inversion (58.8%), and prolonged corrected QT interval (35.3%). The most common TTS type was apical ballooning (88.2%). Treatment during hospitalization typically included beta-blockers (44.4%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (33.3%), and diuretics (22.2%). After treatment, 81.3% of patients were discharged with improved symptoms. Among this group, nine patients (56.3%) were reported to have recovered ventricular wall motion during follow-up. Two patients (12.5%) died following vaccination without resuscitation attempts. CONCLUSIONS TTS is a rare but potentially life-threatening complication of vaccination. Typical TTS symptoms such as chest pain and dyspnoea should be considered alarming symptoms, though nonspecific symptoms are common. The risks of such rare adverse events should be balanced against the risks of infection.
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Affiliation(s)
- Chenlin Li
- Department of CardiologyJieyang People's HospitalJieyangGuangdongChina
| | - Pengyang Li
- Division of Cardiology, Pauley Heart CenterVirginia Commonwealth UniversityRichmondVAUSA
| | | | - Catherine Teng
- Division of Cardiology, Department of MedicineUniversity of Texas San AntonioSan AntonioTXUSA
| | - Ao Shi
- Faculty of MedicineSt George's University of LondonLondonUK
| | - Xiaojia Lu
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMAUSA
| | - Qiying Dai
- Division of CardiologyMayo ClinicRochesterMNUSA
| | - Bin Wang
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
- Clinical Research CenterThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
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Puarattana-aroonkorn S, Tharakaraman K, Suriyawipada D, Ruchirawat M, Fuangthong M, Sasisekharan R, Artpradit C. Rapid and Scalable Production of Functional SARS-CoV-2 Virus-like Particles (VLPs) by a Stable HEK293 Cell Pool. Vaccines (Basel) 2024; 12:561. [PMID: 38932290 PMCID: PMC11209123 DOI: 10.3390/vaccines12060561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 06/28/2024] Open
Abstract
At times of pandemics, such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the situation demands rapid development and production timelines of safe and effective vaccines for delivering life-saving medications quickly to patients. Typical biologics production relies on using the lengthy and arduous approach of stable single-cell clones. Here, we used an alternative approach, a stable cell pool that takes only weeks to generate compared to a stable single-cell clone that needs several months to complete. We employed the membrane, envelope, and highly immunogenic spike proteins of SARS-CoV-2 to produce virus-like particles (VLPs) using the HEK293-F cell line as a host system with an economical transfection reagent. The cell pool showed the stability of protein expression for more than one month. We demonstrated that the production of SARS-CoV-2 VLPs using this cell pool was scalable up to a stirred-tank 2 L bioreactor in fed-batch mode. The purified VLPs were properly assembled, and their size was consistent with the authentic virus. Our particles were functional as they specifically entered the cell that naturally expresses ACE-2. Notably, this work reports a practical and cost-effective manufacturing platform for scalable SARS-CoV-2 VLPs production and chromatographic purification.
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Affiliation(s)
| | - Kannan Tharakaraman
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Disapan Suriyawipada
- Translational Research Unit, Chulabhorn Research Institute, Bangkok 10210, Thailand (M.F.)
| | - Mathuros Ruchirawat
- Translational Research Unit, Chulabhorn Research Institute, Bangkok 10210, Thailand (M.F.)
- Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Bangkok 10400, Thailand
| | - Mayuree Fuangthong
- Translational Research Unit, Chulabhorn Research Institute, Bangkok 10210, Thailand (M.F.)
- Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Bangkok 10400, Thailand
- Program in Applied Biological Sciences, Chulabhorn Graduate Institute, Bangkok 10210, Thailand
| | - Ram Sasisekharan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Charlermchai Artpradit
- Translational Research Unit, Chulabhorn Research Institute, Bangkok 10210, Thailand (M.F.)
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6
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Bhushan R. A narrative review of coronavirus (COVID-19) vaccination and its implication in the development of coronary artery disease: an Indian perspective. Indian J Thorac Cardiovasc Surg 2024; 40:391-393. [PMID: 38681704 PMCID: PMC11045674 DOI: 10.1007/s12055-023-01640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 05/01/2024] Open
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7
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Maruyama T, Uesako H. Lessons Learnt from Case Series of Out-of-hospital Cardiac Arrest and Unexpected Death after COVID-19 Vaccination. Intern Med 2023; 62:3267-3275. [PMID: 37612082 DOI: 10.2169/internalmedicine.2298-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Vaccination against COVID-19 has raised concerns about myocarditis in young men, as out-of-hospital cardiac arrest (OHCA) or sudden death after vaccination has been reported sporadically. Common features of these cases are occurrence in young men, within a few weeks after vaccination, in patients with no structural heart diseases. Cases of unexplained nocturnal death showed fibrotic or hypertrophied myocardium, and one case of OHCA presented ventricular fibrillation (VF) triggered by a prominent J wave on an automated external defibrillator and histopathologic findings compatible with myocarditis. Both myocarditis and J waves are prevalent in young men, and these cases imply that myocarditis augments J waves, which trigger VFs, and primary electrical disorders are a leading cause of death. To prevent such issues, artificial intelligence (AI)-assisted interpretation of historical electrocardiogram findings may help predict future J wave formation leading to VF, as digital electrocardiogram (ECG) findings are well suited for AI interpretation.
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Affiliation(s)
- Toru Maruyama
- Professor Emeritus in Kyushu University, Kyushu University Hospital, Japan
- Haradoi Hospital, Japan
| | - Hayata Uesako
- Department of Internal Medicine, Suwa Central Hospital, Japan
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Alamri T, Anwer F, Butt NS, Alganmi AH, Alotaibi SA, Alzibali KF, Hawsawi HA, Bakarman M, Malik AA. Analyzing COVID-19 Vaccination Side Effects Among the Adult Population in Jeddah, Saudi Arabia. Cureus 2023; 15:e47136. [PMID: 37854474 PMCID: PMC10579840 DOI: 10.7759/cureus.47136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
The COVID-19 pandemic has brought vaccination to the forefront of global attention. The Pfizer-BioNTech vaccine, an mRNA vaccine that encodes the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) glycoprotein spike, has emerged as a significant player in global vaccination efforts. It is generated from lipid nanoparticles and has been subject to various regulatory approvals and authorizations. The United Kingdom became the first country to approve the Pfizer vaccine on December 2, 2020. The World Health Organization (WHO) authorized the emergency use of the Pfizer vaccine on December 31, 2020, facilitating its production and distribution worldwide. In Saudi Arabia, as well as globally, concerns about the safety and effectiveness of vaccines have been raised. Several studies have reported side effects of the Pfizer vaccine, including rare conditions such as myocarditis. In our study, we aimed to systematically investigate the symptoms experienced after vaccination, considering the administration of three doses. We also explored the duration of these symptoms and whether they necessitated hospital visits, primary healthcare interventions, or resolved on their own. Our study employed an online cross-sectional design conducted in Jeddah, Saudi Arabia, utilizing an online self-reported survey. A total of 332 participants who met the predefined criteria were recruited for the study. The rate of COVID-19 infection after 1st and 2nd doses of Pfizer and AstraZeneca vaccines was significantly lower in middle-age subgroups (31-45 years), in comparison to young (18-30 years) and upper middle-age subgroups (46-60 years). For the AstraZeneca vaccine, the infection rate in the middle-aged group was higher after 2nd dose as compared to its 1st dose. Overall, greater infection rates were observed in upper-middle-aged subgroups with all doses of Pfizer and AstraZeneca vaccines. Fatigue and fever were the most common generalized side effects while redness/swelling/pain at the injection site, muscle pain, and joint pain were the most important local side-effects. Fatigue, fever, muscle pain, and joint pain were significantly common after 1st dose of Pfizer and fever was a significant side effect after 2nd dose of Pfizer in comparison to AstraZeneca doses. Understanding the spectrum of side effects associated with the vaccine is crucial for healthcare professionals and individuals receiving the vaccine, as it enables informed decision-making and appropriate management of potential adverse reactions.
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Affiliation(s)
- Turki Alamri
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Fahad Anwer
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Nadeem S Butt
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Ahmed H Alganmi
- Department of Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Sultan A Alotaibi
- Department of Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Khalid F Alzibali
- Department of Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Hassan A Hawsawi
- Department of Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Marwan Bakarman
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Ahmad Azam Malik
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
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Lin Y, Bai W, Su Z, Jackson T, Xiang YT. Prevalence and correlates of COVID-19 vaccine hesitancy among Chinese myocardial infarction survivors: A cross-sectional study. Prev Med Rep 2023; 35:102377. [PMID: 37670909 PMCID: PMC10475500 DOI: 10.1016/j.pmedr.2023.102377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
Individuals with cardiovascular diseases (CVDs) are at increased risk for morbidity and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although vaccinations should be a priority for individuals with high-risk CVDs, some may be hesitant to pursue such interventions. This cross-sectional study was designed to document the prevalence and correlates of COVID-19 vaccine hesitancy among myocardial infarction (MI) patients in China. Participants diagnosed with MI were recruited from Beijing Anzhen Hospital between October 17, 2021 and May 17, 2022. The primary outcome was prevalence rate of COVID-19 vaccine hesitancy. Demographics and attitudes toward vaccination were also assessed as potential correlates of vaccine hesitancy. A total of 565 MI patients were consecutively included for analyses. The percentage of participants that reported vaccine hesitancy was 32.7% (95 %CI: 28.9-36.6%), while 67.3% (95 %CI: 63.4-71.1%) viewed COVID-19 vaccines as safe and without serious side effects. MI patients who were married (OR = 0.47, 95 %CI: 0.23-0.95) and those who thought vaccines were safe (OR = 0.44, 95 %CI: 0.28-0.68) were less likely to report vaccine hesitancy. Conversely, participants who were older (OR = 1.04, 95 %CI: 1.02-1.07) and those who worried about being infected with COVID-19 (OR = 2.03, 95 %CI: 1.35-3.03) were more likely to be vaccine hesitant. A relatively high rate of vaccine hesitancy was found in Chinese MI patients. Immunization remains the leading strategy for reducing the health burden of COVID-19 in vulnerable groups including MI patients. Improving awareness of benefits of COVID-19 vaccines and emphasizing their safety could alleviate potential concerns of vaccine-hesitant MI survivors.
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Affiliation(s)
- Yun Lin
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, University of Macau, Macao SAR, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, University of Macau, Macao SAR, China
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Urakawa R, Isomura ET, Matsunaga K, Kubota K. Multivariate Analysis of Adverse Reactions and Recipient Profiles in COVID-19 Booster Vaccinations: A Prospective Cohort Study. Vaccines (Basel) 2023; 11:1513. [PMID: 37896917 PMCID: PMC10611183 DOI: 10.3390/vaccines11101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND This study investigated the impact of vaccinated population profiles, vaccine type/interval, and the number of vaccine doses on adverse reactions to receiving a coronavirus disease 2019 (COVID-19) booster vaccination. METHODS A survey of adverse reactions was conducted from January 2022 to December 2022 among Osaka University Dental Hospital employees who received their third or fourth doses. The study included 194 third-dose recipients and 131 fourth-dose recipients. Comparisons of the occurrence of adverse reactions between the third- and fourth-dose groups were analyzed via a chi-squared test. The relationships between each adverse reaction occurrence and recipient profiles, vaccine type/interval, and the number of vaccine doses were analyzed via a logistic regression analysis. RESULTS No significant differences were found in the occurrence of adverse reactions between the third and fourth doses. Younger recipients often developed injection site reaction, fatigue, chills, fever, arthralgia, headache, diarrhea, and any adverse reactions more often. Females had higher frequencies of fatigue, chills, headache, and nausea compared to males. Recipients without underlying diseases had higher frequencies of fever and nausea than those with underlying diseases. CONCLUSIONS Younger recipients and females were at higher risk for adverse reactions to a COVID-19 booster vaccination, while the number of vaccinations, vaccination interval, vaccine type, and cross-vaccination showed no significant associations.
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Affiliation(s)
- Ryuta Urakawa
- Department of Pharmacy, Osaka University Dental Hospital, 1-8 Yamada-oka, Suita, Osaka 565-0871, Japan
- Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Emiko Tanaka Isomura
- Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, 1-8 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Kazuhide Matsunaga
- Department of Oral & Maxillofacial Oncology and Surgery, Graduate School of Dentistry, Osaka University, 1-8 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Kazumi Kubota
- Department of Healthcare Information Management, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Khaity A, Rababah AAM, Abdelwahab OA, Albakri K, Diab RA, Al-Dardery NM, Abbassy M, Al-Hanaqtah BM, Awad AK, Mohamad T. Cardiovascular Disease and COVID-19 Vaccines: A Systematic Review and Analysis of Published Cases. Eur Cardiol 2023; 18:e54. [PMID: 37745168 PMCID: PMC10512119 DOI: 10.15420/ecr.2023.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/26/2023] [Indexed: 09/26/2023] Open
Abstract
As vaccination against COVID-19 became more widespread, side-effects that were not initially detected during clinical trials became more prominent. The aim of this systematic review is to discuss reports of adverse cardiovascular events associated with COVID-19 vaccination. Databases were searched from inception up to August 2022 to identify case reports and case series reporting on patients with cardiovascular disease after COVID-19 vaccination. This study assessed 150 published cases. Of these, 109 were case reports and 41 were case series. The majority of patients were male (n=302, 86.6%), with a mean age of 27.6 ± 16.7 years. Of the included patients, 268 (76.6%) had myocarditis, 50 (14.6%) had myopericarditis, 8 (2.3%) had pericarditis, and only 4 (1.1%) had stress-induced cardiomyopathy. Moreover, 30 (8.6%) and 11 (3.1%) were diagnosed with arrhythmia and ischaemic heart disease, respectively. Ultimately, cardiovascular complications after COVID-19 vaccination include myocarditis, myopericarditis, ischaemic heart disease and arrhythmia. The young population, especially young male patients, could be more vulnerable to myocarditis.
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Affiliation(s)
| | | | | | | | | | | | - Mahmoud Abbassy
- Department of Medicine, Royal College of Surgeons in Ireland Dublin, Ireland
| | | | - Ahmed K Awad
- Faculty of Medicine, Ain-Shams University Cairo, Egypt
| | - Tamam Mohamad
- Department of Interventional Cardiology, Wayne State University School of Medicine, Detroit Medical Center Detroit, MI, US
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12
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Pari B, Babbili A, Kattubadi A, Thakre A, Thotamgari S, Gopinathannair R, Olshansky B, Dominic P. COVID-19 Vaccination and Cardiac Arrhythmias: A Review. Curr Cardiol Rep 2023; 25:925-940. [PMID: 37530946 DOI: 10.1007/s11886-023-01921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW In this review, we aim to delve into the existing literature, seeking to uncover the mechanisms, investigate the electrocardiographic changes, and examine the treatment methods of various cardiac arrhythmias that occur after administration of the COVID-19 vaccine. RECENT FINDINGS A global survey has exposed an incidence of arrhythmia in 18.27% of hospitalized COVID-19 patients. Furthermore, any type of COVID-19 vaccine - be it mRNA, adenovirus vector, whole inactivated, or protein subunit - appears to instigate cardiac arrhythmias. Among the cardiac adverse events reported post-COVID-19 vaccination, myocarditis emerges as the most common and is thought to be a potential cause of bradyarrhythmia. When a patient post-COVID-19 vaccination presents a suspicion of cardiac involvement, clinicians should perform a comprehensive history and physical examination, measure electrolyte levels, conduct ECG, and carry out necessary imaging studies. In our extensive literature search, we uncovered various potential mechanisms that might lead to cardiac conduction abnormalities and autonomic dysfunction in patients who have received the COVID-19 vaccine. These mechanisms encompass direct viral invasion through molecular mimicry/spike (S) protein production, an escalated inflammatory response, hypoxia, myocardial cell death, and the eventual scar/fibrosis. They correspond to a range of conditions including atrial tachyarrhythmias, bradyarrhythmia, ventricular arrhythmias, sudden cardiac death, and the frequently occurring myocarditis. For treating these COVID-19 vaccination-induced arrhythmias, we should incorporate general treatment strategies, similar to those applied to arrhythmias from other causes.
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Affiliation(s)
- Bavithra Pari
- Department of Medicine, LSUHSC-S, Shreveport, LA, USA
| | | | | | - Anuj Thakre
- Department of Medicine, LSUHSC-S, Shreveport, LA, USA
| | | | - Rakesh Gopinathannair
- The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center, KS, Kansas City, USA
| | - Brian Olshansky
- Division of Cardiology, Department of Medicine, The University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Paari Dominic
- Division of Cardiology, Department of Medicine, The University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
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13
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Shafiee A, Amini MJ, Arabzadeh Bahri R, Jafarabady K, Salehi SA, Hajishah H, Mozhgani SH. Herpesviruses reactivation following COVID-19 vaccination: a systematic review and meta-analysis. Eur J Med Res 2023; 28:278. [PMID: 37559096 PMCID: PMC10413536 DOI: 10.1186/s40001-023-01238-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The reactivation of herpesviruses (HHV) in COVID-19 patients is evident in the literature. Several reports have been published regarding the reactivation of these viruses (HSV, VZV, EBV, and CMV) among those who got COVID-19 vaccines. In this study, we aimed to review the current evidence to assess whether HHVs reactivation has any association with the prior administration of COVID-19 vaccines. METHODS A systematic search was conducted on 25 September 2022 in PubMed/MEDLINE, Web of Science, and EMBASE. We included all observational studies, case reports, and case series which reported the reactivation of human herpesviruses following administration of COVID-19 vaccines. RESULTS Our systematic search showed 80 articles that meet the eligibility criteria. Among the evaluated COVID-19 vaccines, most of the vaccines were mRNA based. Evidence from observational studies showed the possible relation between COVID-19 vaccine administration and VZV and HSV reactivation. The results of our proportion meta-analysis showed that the rate of VZV reactivation among those who received the COVID-19 vaccine was 14 persons per 1000 vaccinations (95% CI 2.97-32.80). Moreover, our meta-analysis for HSV reactivation showed the rate of 16 persons per 1000 vaccinations (95% CI 1.06-46.4). Furthermore, the evidence from case reports/series showed 149 cases of HHV reactivation. There were several vaccines that caused reactivation including BNT162b2 mRNA or Pfizer-BioNTech (n = 76), Oxford-AstraZeneca (n = 22), mRNA-1273 or Moderna (n = 17), Sinovac (n = 4), BBIBP-CorV or Sinopharm (n = 3), Covaxin (n = 3), Covishield (n = 3), and Johnson and Johnson (n = 1). Reactivated HHVs included varicella-zoster virus (VZV) (n = 114), cytomegalovirus (CMV) (n = 15), herpes simplex virus (HSV) (n = 14), Epstein-Barr virus (EBV) (n = 6), and HHV-6 (n = 2). Most cases reported their disease after the first dose of the vaccine. Many patients reported having comorbidities, of which hypertension, diabetes mellitus, dyslipidemia, chicken pox, and atrial fibrillation were common. CONCLUSION In conclusion, our study showed the possible association between COVID-19 vaccination and herpesvirus reactivation. The evidence for VZV and HSV was supported by observational studies. However, regarding other herpesviruses (EBV and CMV), further research especially from observational studies and clinical trials is required to elucidate the interaction between COVID-19 vaccination and their reactivation.
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Affiliation(s)
- Arman Shafiee
- Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Javad Amini
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Kyana Jafarabady
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyyed Amirhossein Salehi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Hajishah
- Student Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Sayed-Hamidreza Mozhgani
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Non-Communicable Diseases Research Center, Alborz University of Medical, Sciences, Karaj, Iran
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14
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Ceasovschih A, Sorodoc V, Shor A, Haliga RE, Roth L, Lionte C, Onofrei Aursulesei V, Sirbu O, Culis N, Shapieva A, Tahir Khokhar MAR, Statescu C, Sascau RA, Coman AE, Stoica A, Grigorescu ED, Banach M, Thomopoulos C, Sorodoc L. Distinct Features of Vascular Diseases in COVID-19. J Inflamm Res 2023; 16:2783-2800. [PMID: 37435114 PMCID: PMC10332421 DOI: 10.2147/jir.s417691] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic was declared in early 2020 after several unexplained pneumonia cases were first reported in Wuhan, China, and subsequently in other parts of the world. Commonly, the disease comprises several clinical features, including high temperature, dry cough, shortness of breath, and hypoxia, associated with findings of interstitial pneumonia on chest X-ray and computer tomography. Nevertheless, severe forms of acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) are not limited to the respiratory tract but also may be extended to other systems, including the cardiovascular system. The bi-directional relationship between atherosclerosis and COVID-19 is accompanied by poor prognosis. The immune response hyperactivation due to SARS-CoV-2 infection causes an increased secretion of cytokines, endothelial dysfunction, and arterial stiffness, which promotes the development of atherosclerosis. Also, due to the COVID-19 pandemic, access to healthcare amenities was reduced, resulting in increased morbidity and mortality in patients at risk. Furthermore, as lockdown measures were largely adopted worldwide, the sedentary lifestyle and the increased consumption of processed nutrients or unhealthy food increased, and in the consequence, we might observe even 70% of overweight and obese population. Altogether, with the relatively low ratio of vaccinated people in many countries, and important health debt appeared, which is now and will be for next decade a large healthcare challenge. However, the experience gained in the COVID-19 pandemic and the new methods of patients' approaching have helped the medical system to overcome this crisis and will hopefully help in the case of new possible epidemics.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, 700111, Romania
| | - Victorita Sorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, 700111, Romania
| | - Annabelle Shor
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, 700111, Romania
| | - Lynn Roth
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Wilrijk, 2610, Belgium
| | - Catalina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, 700111, Romania
| | | | - Oana Sirbu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, 700111, Romania
| | - Nicolae Culis
- Nottingham University Hospitals NHS Trust, Queen’s Medical Center, Nottingham, NG72UH, UK
| | - Albina Shapieva
- Cardiac Electrophysiology Department, Petrovsky National Research Center of Surgery, Moscow, 119991, Russia
| | | | - Cristian Statescu
- Department of Cardiology, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Iasi, 700503, Romania
| | - Radu A Sascau
- Department of Cardiology, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, Iasi, 700503, Romania
| | - Adorata Elena Coman
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, 700111, Romania
| | - Elena-Daniela Grigorescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, 93338, Poland
| | - Costas Thomopoulos
- Department of Cardiology, Elena Venizelou General Hospital, Athens, GR-11522, Greece
| | - Laurentiu Sorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 700115, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Iasi, 700111, Romania
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15
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Arellano-Arteaga KJ, Bayro Jablonski NE, Miramontes Luna E, Bedolla-Barajas M, Coronel Castañeda LG. Biventricular Takotsubo Cardiomyopathy as an Unusual Presentation of SARS-CoV-2 mRNA Vaccine-Associated Multisystemic Inflammatory Syndrome. Cureus 2023; 15:e41365. [PMID: 37546070 PMCID: PMC10399703 DOI: 10.7759/cureus.41365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Biventricular takotsubo cardiomyopathy (BiTCM) is a rare entity, seldom reported. We describe a case of a female presenting with multisystemic inflammatory syndrome associated with the administration of a vaccine against coronavirus disease 2019 (COVID-19). In this particular case, the patient experienced the onset of symptoms shortly after receiving a COVID-19 vaccine. Early recognition of biventricular takotsubo cardiomyopathy and timely initiation of appropriate treatment are crucial. Prompt management includes stabilizing the patient's hemodynamic status, alleviating symptoms, and addressing any underlying causes, such as inflammation or immune-related responses. Close clinical surveillance is necessary to monitor the patient's cardiac function, assess response to treatment, and prevent potential complications.
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Affiliation(s)
- Kevin J Arellano-Arteaga
- Department of Clinical Medicine/Internal Medicine, University Center for Health Science, University of Guadalajara, Guadalajara, MEX
- Department of Internal Medicine, Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, MEX
| | | | - Elvira Miramontes Luna
- Department of Internal Medicine, Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, MEX
| | - Martín Bedolla-Barajas
- Department of Allergy and Clinical Immunology, Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, MEX
| | - Luz Gardenia Coronel Castañeda
- Department of Clinical Medicine/Internal Medicine, University Center for Health Science, University of Guadalajara, Guadalajara, MEX
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16
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Cocco N, Leibundgut G, Pelliccia F, Cammalleri V, Nusca A, Mangiacapra F, Cocco G, Fanale V, Ussia GP, Grigioni F. Arrhythmias after COVID-19 Vaccination: Have We Left All Stones Unturned? Int J Mol Sci 2023; 24:10405. [PMID: 37373551 DOI: 10.3390/ijms241210405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
SARS-CoV-2 vaccination offered the opportunity to emerge from the pandemic and, thereby, worldwide health, social, and economic disasters. However, in addition to efficacy, safety is an important issue for any vaccine. The mRNA-based vaccine platform is considered to be safe, but side effects are being reported more frequently as more and more people around the world become treated. Myopericarditis is the major, but not the only cardiovascular complication of this vaccine; hence it is important not to underestimate other side effects. We report a case series of patients affected by cardiac arrhythmias post-mRNA vaccine from our clinical practice and the literature. Reviewing the official vigilance database, we found that heart rhythm disorders after COVID vaccination are not uncommon and deserve more clinical and scientific attention. Since the COVID vaccine is the only vaccination related to this side effect, questions arose about whether these vaccines could affect heart conduction. Although the risk-benefit ratio is clearly in favor of vaccination, heart rhythm disorders are not a negligible issue, and there are red flags in the literature about the risk of post-vaccination malignant arrhythmias in some predisposed patients. In light of these findings, we reviewed the potential molecular pathways for the COVID vaccine to impact cardiac electrophysiology and cause heart rhythm disorders.
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Affiliation(s)
- Nino Cocco
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Gregor Leibundgut
- University Heart Center, University Hospital Basel, Petersgraben 4, 4053 Basel, Switzerland
| | - Francesco Pelliccia
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00186 Rome, Italy
| | - Valeria Cammalleri
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Annunziata Nusca
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Fabio Mangiacapra
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, 65122 Chieti, Italy
| | - Valerio Fanale
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
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17
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Matsumori A. Myocarditis and Autoimmunity. Expert Rev Cardiovasc Ther 2023. [PMID: 37243585 DOI: 10.1080/14779072.2023.2219895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Autoimmune myocarditis may develop due to heterogeneous causes. Myocarditis is often caused by viral infections, but it can also be caused by systemic autoimmune diseases. Immune checkpoint inhibitors and virus vaccines induce immune activation, and they can cause the development of myocarditis, as well as several immune-related adverse events. The development of myocarditis is dependent on the genetic factors of the host, and the major histocompatibility complex (MHC) may be an important determinant of the type and severity of the disease. However, non-MHC immunoregulatory genes may also play a role in determining susceptibility. AREA COVERED This review summarizes the current knowledge of the etiology, pathogenesis, diagnosis and treatment of autoimmune myocarditis with a particular focus on viral infection and autoimmunity, and biomarkers of myocarditis. EXPERT OPINION An endomyocardial biopsy may not be the gold standard for the diagnosis of myocarditis. Cardiac magnetic resonance imaging is useful in diagnosing autoimmune myocarditis. Recently identified biomarkers of inflammation and myocyte injury are promising for the diagnosis of myocarditis when measured simultaneously. Future treatments should focus on the appropriate diagnosis of the etiologic agent, as well as on the specific stage of the evolution of immune and inflammatory processes.
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Affiliation(s)
- Akira Matsumori
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
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18
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Hromić-Jahjefendić A, Sezer A, Aljabali AAA, Serrano-Aroca Á, Tambuwala MM, Uversky VN, Redwan EM, Barh D, Lundstrom K. COVID-19 Vaccines and Myocarditis: An Overview of Current Evidence. Biomedicines 2023; 11:biomedicines11051469. [PMID: 37239140 DOI: 10.3390/biomedicines11051469] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
COVID-19 vaccines have been widely used to reduce the incidence and disease severity of COVID-19. Questions have lately been raised about the possibility of an association between COVID-19 vaccines and myocarditis, an inflammatory condition affecting the myocardium, or the middle layer of the heart. Myocarditis can be caused by infections, immune reactions, or toxic exposure. The incidence rate of myocarditis and pericarditis was calculated to be 5.98 instances per million COVID-19 vaccine doses delivered, which is less than half of the incidences after SARS-CoV-2 infection. Myocarditis rates in people aged 12 to 39 years are around 12.6 cases per million doses following the second dose of mRNA vaccination. Adolescent men are more likely than women to develop myocarditis after receiving mRNA vaccines. The objectives of this systematic review and meta-analysis are to find out how often myocarditis occurs after receiving the COVID-19 vaccine, as well as the risk factors and clinical repercussions of this condition. Nevertheless, the causal relationship between vaccination and myocarditis has been difficult to establish, and further research is required. It is also essential to distinguish between suggested cases of myocarditis and those confirmed by endomyocardial biopsy.
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Affiliation(s)
- Altijana Hromić-Jahjefendić
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka cesta 15, 71000 Sarajevo, Bosnia and Herzegovina
| | - Abas Sezer
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka cesta 15, 71000 Sarajevo, Bosnia and Herzegovina
| | - Alaa A A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid 21163, Jordan
| | - Ángel Serrano-Aroca
- Biomaterials and Bioengineering Laboratory, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, c/Guillem de Castro 94, 46001 Valencia, Spain
| | - Murtaza M Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln LN6 7TS, UK
| | - Vladimir N Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer's Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Elrashdy M Redwan
- Department of Biological Science, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, New Borg EL-Arab 21934, Egypt
| | - Debmalya Barh
- Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, India
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
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19
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Scholkmann F, May CA. COVID-19, post-acute COVID-19 syndrome (PACS, "long COVID") and post-COVID-19 vaccination syndrome (PCVS, "post-COVIDvac-syndrome"): Similarities and differences. Pathol Res Pract 2023; 246:154497. [PMID: 37192595 DOI: 10.1016/j.prp.2023.154497] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
Worldwide there have been over 760 million confirmed coronavirus disease 2019 (COVID-19) cases, and over 13 billion COVID-19 vaccine doses have been administered as of April 2023, according to the World Health Organization. An infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to an acute disease, i.e. COVID-19, but also to a post-acute COVID-19 syndrome (PACS, "long COVID"). Currently, the side effects of COVID-19 vaccines are increasingly being noted and studied. Here, we summarise the currently available indications and discuss our conclusions that (i) these side effects have specific similarities and differences to acute COVID-19 and PACS, that (ii) a new term should be used to refer to these side effects (post-COVID-19 vaccination syndrome, PCVS, colloquially "post-COVIDvac-syndrome"), and that (iii) there is a need to distinguish between acute COVID-19 vaccination syndrome (ACVS) and post-acute COVID-19 vaccination syndrome (PACVS) - in analogy to acute COVID-19 and PACS ("long COVID"). Moreover, we address mixed forms of disease caused by natural SARS-CoV-2 infection and COVID-19 vaccination. We explain why it is important for medical diagnosis, care and research to use the new terms (PCVS, ACVS and PACVS) in order to avoid confusion and misinterpretation of the underlying causes of disease and to enable optimal medical therapy. We do not recommend to use the term "Post-Vac-Syndrome" as it is imprecise. The article also serves to address the current problem of "medical gaslighting" in relation to PACS and PCVS by raising awareness among the medical professionals and supplying appropriate terminology for disease.
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Affiliation(s)
- Felix Scholkmann
- University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Christian-Albrecht May
- Department of Anatomy, Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
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20
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Adverse Hematological Effects of COVID-19 Vaccination and Pathomechanisms of Low Acquired Immunity in Patients with Hematological Malignancies. Vaccines (Basel) 2023; 11:vaccines11030662. [PMID: 36992246 DOI: 10.3390/vaccines11030662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
The SARS-CoV-2 virus and the COVID-19 pandemic have spread across the world and severely impacted patients living with hematological conditions. Immunocompromised patients experience rapidly progressing symptoms following COVID-19 infection and are at high risk of death. In efforts to protect the vulnerable population, vaccination efforts have increased exponentially in the past 2 years. Although COVID-19 vaccination is safe and effective, mild to moderate side effects such as headache, fatigue, and soreness at the injection site have been reported. In addition, there are reports of rare side effects, including anaphylaxis, thrombosis with thrombocytopenia syndrome, Guillain-Barré Syndrome, myocarditis, and pericarditis after vaccination. Further, hematological abnormalities and a very low and transient response in patients with hematological conditions after vaccination raise concerns. The objective of this review is to first briefly discuss the hematological adverse effects associated with COVID-19 infection in general populations followed by critically analyzing the side effects and pathomechanisms of COVID-19 vaccination in immunocompromised patients with hematological and solid malignancies. We reviewed the published literature, with a focus on hematological abnormalities associated with COVID-19 infection followed by the hematological side effects of COVID-19 vaccination, and the mechanisms by which complications can occur. We extend this discussion to include the viability of vaccination efforts within immune-compromised patients. The primary aim is to provide clinicians with critical hematologic information on COVID-19 vaccination so that they can make informed decisions on how to protect their at-risk patients. The secondary goal is to clarify the adverse hematological effects associated with infection and vaccination within the general population to support continued vaccination within this group. There is a clear need to protect patients with hematological conditions from infection and modulate vaccine programs and procedures for these patients.
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21
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Brau-Javier CN, Caro-Muniz AP, Canizares O. Facial fat necrosis after autologous fat transfer possibly associated with SARS-CoV-2 vaccine. J Cosmet Dermatol 2023; 22:1477-1480. [PMID: 36891961 DOI: 10.1111/jocd.15635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/03/2023] [Indexed: 03/10/2023]
Abstract
A 52-year-old female patient developed facial fat necrosis presenting with cutaneous induration three weeks after minimal access cranial suspension (MACS) lift with autologous fat grafting from the abdomen. Given that the patient received the Moderna SARS-CoV-2 vaccine one week after surgery, we hypothesize that the former predisposed her to tissue ischemia leading to fat necrosis. Histological findings after biopsy were consistent with fat necrosis, which included marked dermal fibrosis with areas of focal fat necrosis, lipophages, multinucleated giant cells, and siderophages. It is our hope that documenting this rare development in literature may serve as encouragement for adverse effect reporting after the SARS-CoV-2 vaccine administration and may boost inspection and monitoring of other health consequences by regulating agencies.
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Affiliation(s)
- Cristina N Brau-Javier
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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22
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Jamali M, Cherraqi A, Melang Mvomo A, Boukhlifi Y, Alami M, Ameur A. Thrombosis of the deep dorsal vein of the penis caused by vaccine-induced thrombotic thrombocytopenia: First reported case. Arab J Urol 2023; 21:36-39. [PMID: 36818370 PMCID: PMC9930863 DOI: 10.1080/2090598x.2022.2127236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The first described case of deep dorsal vein thrombosis of the penis secondary to vaccine-induced thrombotic thrombocytopenia (VITT), a complication of COVID adenoviral vector vaccines. The patient reported pain in the penis one month after vaccination. On ultrasound, a deep dorsal vein thrombosis was found and a biological workup was ordered to confirm the VITT trail. Anticoagulant therapy was immediately initiated and the patient responds well while suffering from erectile dysfunction. VITT is a potentially serious event that can be life-threatening; every practitioner should know how to deal with it.
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Affiliation(s)
- Mounir Jamali
- Urology Department, Mohammed V Military Hospital, Rabat, Morocco,CONTACT Mounir Jamali Urology Department, Mohammed V Military Hospital, Hay Ryad 10100 - Rabat, Morocco
| | - Amine Cherraqi
- Radiology Department, Mohammed V Military Hospital, Rabat, Morocco
| | | | | | - Mohammed Alami
- Urology Department, Mohammed V Military Hospital, Rabat, Morocco
| | - Ahmed Ameur
- Urology Department, Mohammed V Military Hospital, Rabat, Morocco
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23
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Wang WH, Wei KC, Huang YT, Huang KH, Tsai TH, Chang YC. The Incidence of Myocarditis Following an Influenza Vaccination: A Population-Based Observational Study. Drugs Aging 2023; 40:145-151. [PMID: 36626028 PMCID: PMC9838541 DOI: 10.1007/s40266-022-00997-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Recently, studies have pointed to a link between coronavirus disease 2019 vaccinations and myocarditis. Myocarditis following an influenza vaccine has been sporadically reported. However, it is not known whether this adverse event occurs among elderly individuals who have received influenza vaccines. We used a population-based database and a self-controlled case-series design to estimate the incidence of myocarditis following an influenza vaccination. METHODS Data were extracted from Taiwan's National Health Insurance Research Database. The study population consisted of elderly people aged ≥ 65 years who had de novo myocarditis, which required hospitalization, within 6 months after receiving an influenza vaccination between 2003 and 2017. The first 1-7, 1-14, and 1-42 days after vaccination were defined as risk intervals, and the other periods were defined as control intervals. Poisson regression was used to calculate the incidence rate ratio for myocarditis between the risk and control periods. RESULTS Within 180 days following a vaccination, 191 people were hospitalized for myocarditis among 19,678,904 people. In comparison with control intervals, the incidence rate ratios of an admission for myocarditis for days 1-7, 1-14, and 1-42 were 0.80 (95% confidence interval 0.36-1.81), 0.72 (95% confidence interval 0.39-1.32), and 0.73 (95% confidence interval 0.50-1.05), respectively. Subgroup analyses by sex, age, Charlson Comorbidity Index scores, and comorbidities did not yield significant differences in the incidence rate ratio. CONCLUSIONS Regardless of the post-vaccination time and underlying baseline characteristics, the incidence risk of myocarditis is not significantly increased in the elderly following an influenza vaccination.
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Affiliation(s)
- Wen-Hwa Wang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- College of Management, I-Shou University, Kaohsiung, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Department of Medical Research and Development, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yu-Chia Chang
- Department of Long Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, 892009, Taiwan.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, 41354, Taiwan.
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24
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Restrepo MI, Marin-Corral J, Rodriguez JJ, Restrepo V, Cavallazzi R. Cardiovascular Complications in Coronavirus Disease 2019-Pathogenesis and Management. Semin Respir Crit Care Med 2023; 44:21-34. [PMID: 36646083 DOI: 10.1055/s-0042-1760096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused a devastating impact on morbidity and mortality around the world. Severe acute respiratory syndrome-coronavirus-2 has a characteristic tropism for the cardiovascular system by entering the host cells and binding to angiotensin-converting enzyme 2 receptors, which are expressed in different cells, particularly endothelial cells. This endothelial injury is linked by a direct intracellular viral invasion leading to inflammation, microthrombosis, and angiogenesis. COVID-19 has been associated with acute myocarditis, cardiac arrhythmias, new onset or worsening heart failure, ischemic heart disease, stroke, and thromboembolic disease. This review summarizes key relevant literature regarding the epidemiology, diagnosis, treatment, and preventive measures related to cardiovascular complications in the setting of COVID-19.
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Affiliation(s)
- Marcos I Restrepo
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas.,Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, Texas
| | - Judith Marin-Corral
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas.,Critical Care Department, Hospital del Mar-IMIM; Critical Illness Research Group (GREPAC), Barcelona, Spain.,Department of Critical Care, Critical Illness Research Group (GREPAC), Barcelona, Spain
| | - Juan J Rodriguez
- Department of Medicine, Universidad Autónoma de Bucaramanga, Colombia
| | - Valeria Restrepo
- Department of Biology, University of Texas San Antonio - UTSA, San Antonio, Texas
| | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky
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25
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Davis MG, Bobba A, Majeed H, Bilal MI, Nasrullah A, Ratmeyer GM, Chourasia P, Gangu K, Farooq A, Avula SR, Sheikh AB. COVID-19 With Stress Cardiomyopathy Mortality and Outcomes Among Patients Hospitalized in the United States: A Propensity Matched Analysis Using the National Inpatient Sample Database. Curr Probl Cardiol 2023; 48:101607. [PMID: 36690311 PMCID: PMC9859766 DOI: 10.1016/j.cpcardiol.2023.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Takotsubo syndrome (stress cardiomyopathy) has become a well-known complication of COVID-19 infections, with limited large-scale studies evaluating outcomes. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without stress cardiomyopathy. A total of 1,659,040 patients were included in the study: COVID-19 with stress cardiomyopathy (n = 1665, 0.1%) and COVID-19 without stress cardiomyopathy (n = 1657, 375, and 99.9%). The primary outcome was in-hospital mortality, with secondary analysis with propensity matching performed to confirm results from traditional multivariate analysis. COVID-19 patients with stress cardiomyopathy had significantly increased in-hospital mortality compared to COVID-19 patients without stress cardiomyopathy (32.8% vs 14.6%, adjusted OR [aOR]: 2.3 [95% CI, 1.2-4.5], P = 0.01) along with significantly increased mechanical ventilation and vasopressor support, hospitalization charge, acute kidney injury requiring hemodialysis, cardiogenic shock, and cardiac arrest. These results emphasize the need for more research to reduce worse outcomes with COVID-19-related stress cardiomyopathy patients.
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Affiliation(s)
- Monique G Davis
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Aniesh Bobba
- Department of Medicine, John H Stronger Hospital, Cook County, Chicago, IL
| | - Harris Majeed
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Muhammad I Bilal
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA
| | - Glenn M Ratmeyer
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Prabal Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA.
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, TX
| | - Sindhu R Avula
- Department of Interventional Cardiology, Division of Cardiology, University of Kansas, St Francis Campus, Kansas City, KS
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
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26
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No evidence of an increased risk for cardiac complications following mRNA COVID-19 vaccines. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:64. [PMID: 36621253 PMCID: PMC9817719 DOI: 10.1016/j.eimce.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 01/09/2023]
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27
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Alkhalifah JM, Al Seraihi A, Al-Tawfiq JA, Alshehri BF, Alhaluli AH, Alsulais NM, Alessa MM, Seddiq W, Aljeri T, Qahtani MH, Barry M, Al-Otaiby M. Pattern of self-reported adverse events related to COVID-19 vaccines in Saudi Arabia: A nationwide study. Front Public Health 2023; 11:1043696. [PMID: 36908451 PMCID: PMC9995884 DOI: 10.3389/fpubh.2023.1043696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Background Vaccination against coronavirus disease 2019 (COVID-19) is the most effective way to end the pandemic. Any development of adverse events (AEs) from various vaccines should be reported. We therefore aimed to explore major and minor AEs among vaccinated individuals in Saudi Arabia. Methods This is a nationwide report based on the Saudi Arabian Ministry of Health (MOH) registry. It included those who received COVID-19 vaccines from 17th December 2020 to 31st December 2021. The study included spontaneous self-reported adverse effects to COVID-19 vaccines where the study participants used a governmental mobile app (Sehhaty) to report their AEs following vaccination using a checklist option that included a selection of side-effects. The primary outcome was to determine AEs reported within 14 days of vaccination which included injection site itching, pain, reaction, redness, swelling, anxiety, dizziness, fever, headache, hoarseness, itchiness, loss of consciousness, nausea, heartburn, sleep disruption, fatigue, seizures, anaphylaxis, shortness of breath, wheezing, swelling of lips, face, and throat, loss of consciousness, and admissions into the intensive care unit (ICU). Results The study included a total number of 28,031 individuals who reported 71,480 adverse events (AEs); which were further classified into minor and major adverse events including ICU admissions post vaccination. Of the reported AEs, 38,309 (53. 6%) side-effects were reported following Pfizer-BioNTech, 32,223 (45%) following Oxford-AstraZeneca, and 948 (1.3%) following Moderna. The following reported AEs were statistically significant between the different vaccine types: shortness of breath\difficulty of breathing, dizziness, fever above 39°C, headache, hoarseness, injection site reactions, itchiness, nausea, sleep disruption, fatigue, wheezing, swelling of lips/face and\or throat, and loss of consciousness (p-value < 0.05). Fever and seizure were the only statistically significant AEs amongst the number of vaccine doses received (p-value < 0.05). Ten ICU admissions were reported in the 14 days observation period post-COVID-19 vaccination with the following diagnoses: acute myocardial infarction, pneumonia, atherosclerosis, acute respiratory failure, intracranial hemorrhage, grand mal seizure, Guillain-Barré syndrome, abnormal blood gas levels, and septic shock. Conclusion This study demonstrated that the most prevalent SARS-CoV-2 vaccine side-effects among adults in Saudi Arabia were mild in nature. This information will help reduce vaccine hesitancy and encourage further mass vaccination to combat the COVID-19 pandemic, especially as booster doses are now available. Further studies are warranted to obtain a better understanding of the association between risk factors and the experiencing of side-effects post vaccination.
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Affiliation(s)
| | | | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | | | | | - Waleed Seddiq
- Center for Stem Cell and Translational Immunotherapy (CSTI), Harvard Medical School, Boston, MA, United States.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | | | - Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Maram Al-Otaiby
- The Saudi Ministry of Health, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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28
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Ghasemi H, Kazemian S, Nejadghaderi SA, Shafie M. Takotsubo syndrome and COVID‐19: A systematic review. Health Sci Rep 2023; 6:e972. [PMID: 36479387 PMCID: PMC9718950 DOI: 10.1002/hsr2.972] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Aims Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is characterized by acute and transient left ventricular dysfunction and has increased during the COVID-19 pandemic. Herein, we aim to review studies on TTS that were associated with COVID-19 infection, vaccine, and other COVID-19-related etiologies including psychosocial stressors. Methods We systematically searched PubMed, EMBASE, and Scopus up to May 12, 2022. We included case reports, case series, and original articles that reported at least one TTS case associated with COVID-19, or TTS cases after receiving COVID-19 vaccines, or TTS cases secondary to psychological stress due to the COVID-19 pandemic. The quality assessment was conducted using the Joanna Briggs Institute checklist. Results Sixty-seven articles including 102 cases were included. Hypertension was the most frequently accompanying comorbidity (N = 67 [65.6%]) and the mean left ventricular ejection fraction was 36.5%. Among COVID-19 patients, the in-hospital mortality rate was 33.3%. On the other hand, only one COVID-19-negative individual expired (2.3%). The most common presenting clinical symptom was dyspnea in 42 (73.6%) patients. the mean time interval from the first symptom to admission was 7.2 days. The most common chest imaging finding was ground-glass opacity which was reported in 14 (31.1%) participants. The most common abnormalities were T-wave inversion in 35 (43.2%) and ST-segment elevation in 30 (37%). Brain natriuretic peptide and troponin were elevated in 94.7% and 95.9% of participants, respectively. Conclusion The TTS in patients with COVID-19 is almost rare, whereas it could lead to a great mortality and morbidity. An individual with COVID-19, especially an elderly woman, presented with dyspnea in addition to a rise in brain natriuretic peptide and troponin should be evaluated for TTS.
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Affiliation(s)
- Hoomaan Ghasemi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
| | - Sina Kazemian
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran
- Systematic Review and Meta‐Analysis Expert Group (SRMEG) Universal Scientific Education and Research Network (USERN) Tehran Iran
| | - Mahan Shafie
- School of Medicine Tehran University of Medical Sciences Tehran Iran
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29
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Paknahad MH, Yancheshmeh FB, Soleimani A. Cardiovascular complications of COVID-19 vaccines: A review of case-report and case-series studies. Heart Lung 2023; 59:173-180. [PMID: 36842342 PMCID: PMC9905103 DOI: 10.1016/j.hrtlng.2023.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND There are multiple reviews on cardiovascular aspects of COVID-19 disease on cardiovascular system in different population but there is lack of evidence about cardiovascular adverse effects of COVID vaccines. OBJECTIVES The purpose of this study was to compare the cardiac complications of COVID19 vaccines, based on vaccine type (mRNA, vector-based, and inactivated vaccines). METHODS A systematic search was performed covering PubMed for English case-reports and case-series studies, and finally 100 studies were included. RESULTS Myocarditis (with overall rate around 1.62%) was shown to be the most common post-COVID19 immunization cardiac event. More than 90% of post-COVID19 vaccination myocarditis occurred after receiving mRNA vaccines (Moderna & Pfizer-BioNTech), but the report of this event was less in the case of vector-based vaccinations and/or inactivated vaccines. Myocarditis was reported more commonly in men and following the second dose of the immunization. Takotsubo cardiomyopathy (TTC) was reported after mRNA (more commonly) and vector-based vaccinations, with no case report after inactivated vaccines. When mRNA and vector-based vaccinations were used instead of inactivated vaccines, a greater frequency of vaccine-induced thrombotic thrombocytopenia (VITT) and pulmonary emboli (PE) was reported. Myocardial infarction/cardiac arrest was recorded in those beyond the age of 75 years. CONCLUSION The personal and public health benefits of COVID-19 vaccination much outweigh the minor cardiac risks. Reporting bias, regarding more available mRNA vaccines in developed countries, may conflict these results.
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Affiliation(s)
- Mohammad Hossein Paknahad
- Cardiologist, Cardiology Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatereh Baharlouei Yancheshmeh
- Cardiologist, Cardiology Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Soleimani
- Associate Professor of Cardiology, Echocardiologist, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Echocardiography Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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30
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Martins-Filho PR, Sousa ACS. No evidence of an increased risk for cardiac complications following mRNA COVID-19 vaccines. Enferm Infecc Microbiol Clin 2023; 41:64. [PMID: 36278120 PMCID: PMC9574941 DOI: 10.1016/j.eimc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Paulo Ricardo Martins-Filho
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, SE, Brazil
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brazil
| | - Antônio Carlos Sobral Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, SE, Brazil
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31
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Varga I, Michalka P, Mištinová JP. Complications after administration of mRNA vaccine against COVID-19 - case report and short review. VNITRNI LEKARSTVI 2023; 69:20-27. [PMID: 37468319 DOI: 10.36290/vnl.2023.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The pandemic of the disease COVID-19 (COronaVIrus Disease 2019) caused by the SARS-CoV-2 coronavirus (severe acute respiratory syndrome coronavirus 2) resulted in millions of deaths and many patients have chronic consequences after overcoming the acute condition. Several vaccines have been developed in an effort to stop the spread of the virus, but they have potentially serious adverse effects. We present a case report of a patient with acute (myocarditis, exacerbation of bronchial asthma) and long-term (postural orthostatic tachycardia syndrome - POTS) complications after vaccination with the second dose of mRNA vaccine BNT162b2 (Comirnaty®). Treatment consists of regimen measures, numerous pharmacotherapy (metoprolol, ivabradine, corticosteroids, antihistamines, antiphlogistics, bronchodilators) and several nutraceuticals (maritime pine bark extract, quercetin, vitamins, magnesium, phosphatidylcholine). In the discussion, we analyze post-vaccination injury and present a short review of the current literature.
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32
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Chen P, Shi X, He W, Zhong G, Tang Y, Wang H, Zhang P. mRNA vaccine-a desirable therapeutic strategy for surmounting COVID-19 pandemic. Hum Vaccin Immunother 2022; 18:2040330. [PMID: 35321627 PMCID: PMC8973374 DOI: 10.1080/21645515.2022.2040330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 12/18/2022] Open
Abstract
As an acute respiratory infectious disease, COVID-19 threatens the safety of global public health. Given the current lack of specific treatment against this disease, research and development of vaccines have become sharp weapons for overcoming the pandemic. mRNA vaccines have become the lead in COVID-19 vaccination strategies due to their advantages, such as rapid industrial production and efficacy. A total of 137 COVID-19 vaccines have entered the clinical trial stage, among which 23 are mRNA vaccines, accounting for 17% of the total vaccines. Herein, we summarize the research and developmental processes of mRNA vaccines as well as the approach for protecting the human body against infection. Focusing on the latest clinical trial data of two COVID-19 mRNA vaccines from Pfizer and Modena, we discuss their effectiveness and safety. Finally, we analyze the challenges and problems that mRNA vaccines face in controlling the COVID-19 pandemic.
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Affiliation(s)
- Peixian Chen
- Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, Peopleʻs Republic of China
| | - Xiaoye Shi
- Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, Peopleʻs Republic of China
| | - Weixin He
- Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, No, Guangzhou, Guangdong, Peopleʻs Republic of China
| | - Guowei Zhong
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, Peopleʻs Republic of China
| | - Yan Tang
- Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, Peopleʻs Republic of China
| | - Hailin Wang
- Department of Cardiology, Heart Center, Peopleʻs Hospital of Guangning County, Zhaoqing City, Guangdong, Peopleʻs Republic of China
| | - Peidong Zhang
- Department of Cardiology, Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, Peopleʻs Republic of China
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33
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Piché‐Renaud P, Morris SK, Top KA. A narrative review of vaccine pharmacovigilance during mass vaccination campaigns: Focus on myocarditis and pericarditis after COVID-19 mRNA vaccination. Br J Clin Pharmacol 2022; 89:967-981. [PMID: 36480113 PMCID: PMC9878271 DOI: 10.1111/bcp.15625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccines have had a tremendous impact on reducing the burden of infectious diseases; however, they have the potential to cause adverse events following immunization (AEFIs). Prelicensure clinical trials are limited in their ability to detect rare AEFIs that may occur in less than one per thousand individuals. While postmarketing surveillance systems have shown COVID-19 mRNA vaccines to be safe, they led to the identification of rare cases of myocarditis and pericarditis after COVID-19 vaccination that were not initially detected in clinical trials. In this narrative review, we highlight concepts of vaccine pharmacovigilance during mass vaccination campaigns and compare the approaches used in the context of myocarditis and pericarditis following COVID-19 vaccination to historical examples. We describe mechanisms of passive and active surveillance, their strengths and limitations, and how they interacted to identify and characterize the safety signal of myocarditis and pericarditis after COVID-19 mRNA vaccination. Articles were synthesized from a PubMed search using relevant keywords for articles published on vaccine surveillance systems and myocarditis and pericarditis after COVID-19 vaccination, as well as the authors' collections of relevant publications and grey literature reports. The global experience around the identification and monitoring of myocarditis and pericarditis after COVID-19 mRNA vaccination has provided important lessons for vaccine safety surveillance and highlighted its importance in maintaining public trust in mass vaccination programmes in a pandemic context.
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Affiliation(s)
| | - Shaun K. Morris
- Division of Infectious DiseasesThe Hospital for Sick ChildrenTorontoOntarioCanada,Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of Pediatrics, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Clinical Public Health, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Karina A. Top
- Department of PediatricsDalhousie University and Canadian Center for Vaccinology, IWK Health CentreHalifaxNova ScotiaCanada
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34
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Chiewchalermsri C, Hengkrawit K, Srinithiwat P, Kiatsermkachorn W, Luecha O. Risk of Adverse Events of Live-Attenuated COVID-19 Vaccination Among Atopic Patients. J Asthma Allergy 2022; 15:1605-1621. [PMID: 36387834 PMCID: PMC9662003 DOI: 10.2147/jaa.s386611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/28/2022] [Indexed: 12/01/2023] Open
Abstract
PURPOSE Atopic patients have more risk of adverse drug reactions. COVID-19 vaccination is very important in the current situation. We still do not have data about risks of adverse effects from vaccine in atopic patients. The goal of our study was to evaluate atopic risks and adverse effects of live-attenuated Oxford/AstraZeneca COVID-19 vaccination. PATIENTS AND METHODS Data was collected using a prospective descriptive cohort study from participants 18 years old and above who came to the Outpatient Department, Panyananthaphikkhu Chonprathan Medical Center for live-attenuated COVID-19 vaccination between March and December 2021. The sample size was 3016 individuals. The information about adverse reactions at 6, 2, 72 hours and 7.30 and 60 days after each live-attenuated Oxford/AstraZeneca COVID-19 vaccination was collected by telephone. Participants with history of severe allergic reaction to vaccine components were excluded. RESULTS There were 732 atopic patients and 2284 non-atopic patients. Atopic patients included 556 with allergic rhinitis, 83 with asthma, 23 with urticaria and 73 with food allergies. The underlying diseases of hypertension, hyperlipidemia and hyperthyroidism were more common in non-allergic patients, with p-value <0.001, <0.001 and 0.042, respectively. Atopic patients developed significantly more fever, nausea and vomiting, skin rash (urticaria), and local reaction than non-atopic patients, with p-values of <0.001, 0.018, <0.001 and <0.001, respectively. CONCLUSION Atopic patients had more risk of adverse reactions to live-attenuated Oxford/AstraZeneca COVID-19 vaccination. No life-threatening adverse reaction was seen. Physicians should screen atopic risks in people who are getting vaccinated. Atopic patients should be knowledgeable about their risk and how to monitor clinical reactions by themselves.
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Affiliation(s)
- Chirawat Chiewchalermsri
- Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Kitchawan Hengkrawit
- Department of Pediatrics, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Palakorn Srinithiwat
- Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Wipawee Kiatsermkachorn
- Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Orawin Luecha
- Department of Pediatrics, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
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Li YE, Wang S, Reiter RJ, Ren J. Clinical cardiovascular emergencies and the cellular basis of COVID-19 vaccination: from dream to reality? Int J Infect Dis 2022; 124:1-10. [PMID: 36075372 PMCID: PMC9444584 DOI: 10.1016/j.ijid.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES SARS-CoV-2 is responsible for the global COVID-19 pandemic, with little prevention or treatment options. More than 600 million mortalities have been documented from SARS-CoV-2 infection, with the majority of fatalities occurring among elderly patients (aged >65 years). A number of vaccines have been developed in an effort to restrain the rapid spread of SARS-CoV-2. Considering the widespread administration of these vaccines, substantial side or undesired effects in multiple organ systems have emerged, necessitating essential critical care. Herein, we tabulate the adverse cardiovascular responses resulting from COVID-19 vaccines. DESIGN OR METHODS We searched PubMed for articles published through April, 2022, with the terms "SARS-CoV-2", "COVID-19", "cardiovascular", "SARS-CoV-2 vaccines", "COVID-19 vaccines", "myocarditis", "pericarditis", "thrombosis", "thrombocytopenia", "vaccine-induced thrombotic thrombocytopenia", "acute coronary syndrome", "myocardial infarction", "hypertension", "arrythmia", "postural orthostatic tachycardia syndrome", "Takotsubo cardiomyopathy", "cardiac arrest" and "death". We mainly selected publications from the past 3 years, but did not exclude widely referenced and highly regarded older publications. Besides, we searched the reference lists of articles identified by above search method and chose those we considered relevant. RESULTS COVID-19 vaccines evoke rare but fatal thrombotic events, whereas messenger RNA\055based vaccines appear to be associated with risks of pericarditis/myocarditis, with the latter being more predominant in young adults following the second dose. Reports of other cardiovascular responses, including hypertension, arrhythmia, acute coronary syndrome, and cardiac arrest, have also been indicated. CONCLUSION The undesired cardiovascular complications remain infrequent, giveng the large number of vaccinations inoculated to general population. And lower mortality takes precedence over the undesired cardiovascular complications.
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Affiliation(s)
- Yiran E. Li
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shuyi Wang
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Russel J. Reiter
- Department of Cellular and Structural Biology, UT Health San Antonio, San Antonio, USA
| | - Jun Ren
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China,Corresponding author
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Mustafa Alhussein M, Rabbani M, Sarak B, Dykstra S, Labib D, Flewitt J, Lydell CP, Howarth AG, Filipchuck N, Kealey A, Colbert J, Guron N, Kolman L, Merchant N, Bandali M, Bristow M, White JA. Natural History of Myocardial Injury After COVID-19 Vaccine-Associated Myocarditis. Can J Cardiol 2022; 38:1676-1683. [PMID: 35944800 PMCID: PMC9356639 DOI: 10.1016/j.cjca.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/26/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Acute myocarditis is a rare complication of mRNA-based COVID-19 vaccination. Little is known about the natural history of this complication. METHODS Baseline and convalescent (≥ 90 days) cardiac magnetic resonance (CMR) imaging assessments were performed in 20 consecutive patients meeting Updated Lake Louise Criteria for acute myocarditis within 10 days of mRNA-based vaccination. CMR-based changes in left ventricular volumes, mass, ejection fraction (LVEF), markers of tissue inflammation (native T1 and T2 mapping), and fibrosis (late gadolinium enhancement [LGE] and extracellular volume [ECV]) were assessed between baseline and convalescence. Cardiac symptoms and clinical outcomes were captured. RESULTS Median age was 23.1 years (range 18-39 years), and 17 (85%) were male. Convalescent evaluations were performed at a median (IQR) 3.7 (3.3-6.2) months. The LVEF showed a mean 3% absolute improvement, accompanied by a 7% reduction in LV end-diastolic volume and 5% reduction in LV mass (all P < 0.015). Global LGE burden was reduced by 66% (P < 0.001). Absolute reductions in global T2, native T1, and ECV of 2.1 ms, 58 ms, and 2.9%, repectively, were documented (all P ≤ 0.001). Of 5 patients demonstrating LVEF ≤ 50% at baseline, all recovered to above this threshold in convalescence. A total of 18 (90%) patients showed persistence of abnormal LGE although mean fibrosis burden was < 5% of LV mass in 85% of cases. No patient experienced major clinical outcomes. CONCLUSIONS COVID-19 mRNA vaccine-associated myocarditis showed rapid improvements in CMR-based markers of edema, contractile function, and global LGE burden beyond 3 months of recovery in this young patient cohort. However, regional fibrosis following edema resolution was commonly observed, justifying need for ongoing surveillance.
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Affiliation(s)
- Muhammad Mustafa Alhussein
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mohamad Rabbani
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bradley Sarak
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carmen P. Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neil Filipchuck
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angela Kealey
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jillian Colbert
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nita Guron
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Louis Kolman
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Murad Bandali
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mike Bristow
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Corresponding author: Dr James A. White, Stephenson Cardiac Imaging Centre, #0700, SSB, Foothills Medical Centre, 1403-29th St NW, Calgary, Alberta T2N 2T9, Canada. Tel.: +1-403-944-8806; fax: +1-403-944-8510
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Tan LJ, Koh CP, Lai SK, Poh WC, Othman MS, Hussin H. A systemic review and recommendation for an autopsy approach to death followed the COVID 19 vaccination. Forensic Sci Int 2022; 340:111469. [PMID: 36162300 PMCID: PMC9487151 DOI: 10.1016/j.forsciint.2022.111469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/28/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022]
Abstract
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in December 2019. An immediate prevention approach for the outbreak is the development of a vaccination program. Despite a growing number of publications showing the effectiveness of vaccination in preventing SARS-CoV-2 outbreak and reducing the mortality rate, substantial fatal adverse effects were reported after vaccination. Confirmation of the causal relationship of death is required to reimburse under the national vaccination program and could provide a reference for the selection of vaccination. However, a lack of guidelines in the laboratory study and autopsy approach hampered the investigation of post-vaccination death. In this paper, we performed a systematic electronic search on scientific articles related to severe Covid-19 vaccination adverse effects and approaches in identifying the severe side effects using PubMed and Cochrane libraries. A summary on the onset, biochemistry changes and histopathological analyzes of major lethally side effects post-vaccination were discussed. Ultimately, a checklist is suggested to improve the quality of investigation.
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Affiliation(s)
- Lii Jye Tan
- Department of Forensic Medicine, Hospital Raja Permaisuri Bainun, Ipoh, Perak Darul Ridzuan, Malaysia.
| | - Cai Ping Koh
- Department of Biochemistry, Faculty of Medicine, Quest International University, Malaysia
| | - Shau Kong Lai
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Woon Cheng Poh
- Department of Biochemistry, Faculty of Medicine, Quest International University, Malaysia
| | - Mohammad Shafie Othman
- Department of Forensic Medicine, Hospital Raja Permaisuri Bainun, Ipoh, Perak Darul Ridzuan, Malaysia
| | - Huzlinda Hussin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
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Lim KH, Park JS. COVID-19 Vaccination-Induced Ventricular Fibrillation in an Afebrile Patient With Brugada Syndrome. J Korean Med Sci 2022; 37:e306. [PMID: 36325610 PMCID: PMC9623033 DOI: 10.3346/jkms.2022.37.e306] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
A 43-year-old man presented with cardiac arrest 2 days after the second coronavirus disease 2019 (COVID-19) vaccination with an mRNA vaccine. Electrocardiograms showed ventricular fibrillation and type 1 Brugada pattern ST segment elevation. The patient reported having no symptoms, including febrile sensation. There were no known underlying cardiac diseases to explain such electrocardiographic abnormalities. ST segment elevation completely disappeared in two weeks. Although there were no genetic mutations or personal or family history typical of Brugada syndrome, flecainide administration induced type 1 Brugada pattern ST segment elevation. This case suggests that COVID-19 vaccination may induce cardiac ion channel dysfunction and cause life threatening ventricular arrhythmias in specific patients with Brugada syndrome.
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Affiliation(s)
- Kyung Hee Lim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Jong-Sung Park
- Department of Cardiology, Dong-A University Hospital, Busan, Korea.
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Zafar U, Zafar H, Ahmed MS, Khattak M. Link between COVID-19 vaccines and myocardial infarction. World J Clin Cases 2022; 10:10109-10119. [PMID: 36246837 PMCID: PMC9561578 DOI: 10.12998/wjcc.v10.i28.10109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/20/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vaccines for coronavirus disease 2019 (COVID-19) include ChAdOx1-SARS-COV-2 (AstraZeneca), Ad26.COV2.S (Janssen), mRNA-1273 (Moderna), BNT162b2 (Pfizer), BBIBP-CorV (Sinopharm), CoronaVac (Sinovac), and Bharat Biotech BBV152 (Covaxin).
AIM To find the association between COVID-19 vaccines and myocardial infarction (MI).
METHODS This is a systematic review that involved searching databases such as MEDLINE, EMBASE, and PakMediNet after making a search strategy using MeSH and Emtree terms. Eligibility criteria were set, and studies having no mention of MI as a complication of COVID-19 vaccination, protocols, genetic studies, and animal studies were excluded. Data was extracted using a predesigned extraction table, and 29 studies were selected after screening and applying the eligibility criteria.
RESULTS The majority of studies mentioned AstraZeneca (18 studies) followed by Pfizer (14 studies) and Moderna (9 studies) in subjects reporting MI after vaccination. Out of all the studies, 69% reported MI cases after the first COVID-19 vaccination dose and 14% after the second, 44% reported ST-segment elevation MI, and 26% reported non-ST-segment elevation MI. The mortality rate was 29% after MI.
CONCLUSION In conclusion, many studies linked MI to COVID-19 vaccinations, but no definitive association could be found.
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Affiliation(s)
- Umema Zafar
- Department of Physiology, Khyber Medical College, Peshawar 25000, Pakistan
| | - Hamna Zafar
- Department of Medicine, Khyber Teaching Hospital, Peshawar 25000, Pakistan
| | - Mian Saad Ahmed
- Department of Forensic Medicine, Khyber Medical College, Peshawar 25000, Pakistan
| | - Madiha Khattak
- Department of Physiology, Khyber Medical College, Peshawar 25000, Pakistan
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40
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Akinrinmade AO, Obitulata-Ugwu VO, Obijiofor NB, Victor F, Chive M, Marwizi FM, Odion-Omonhimin LO, Obasi NB. COVID-19 and Acute Coronary Syndrome: A Literature Review. Cureus 2022; 14:e29747. [PMID: 36324350 PMCID: PMC9617587 DOI: 10.7759/cureus.29747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019, also known as the COVID-19 pandemic has had a deleterious impact on daily living, with health and socioeconomic effects of a global magnitude. Acute coronary syndrome (ACS), an important cardiovascular disease with significant morbidity and mortality rates, has been frequently reported in patients with this novel virus. This review aims to discuss the potential associations between COVID-19 and ACS with the use of multiple databases, including but not limited to; PubMed, ScienceDirect, World Health Organization, and American Heart Association. We have explored the pathophysiology of ACS, focusing on COVID-19 in particular with the use of various works of literature that highlights the pattern of viral entry and replication via the angiotensin-converting enzyme II. The review has also discussed the impact of the pandemic on hospital admissions, diagnosis, and management of ACS patients, as well as briefly highlighted a possible link between the widely available COVID-19 vaccines and possible cardiovascular complications. The association between COVID-19 and ACS needs more in-depth studies to help establish whether there exists a direct causal and or inciting correlation between them. Understanding this association might lead to new research and treatment options for ACS patients.
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41
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Kaviani R, Farrell J, Dehghan N, Moosavi S. Single organ hepatic artery vasculitis as an unusual cause of epigastric pain: A case report. World J Clin Cases 2022; 10:9384-9389. [PMID: 36159425 PMCID: PMC9477682 DOI: 10.12998/wjcc.v10.i26.9384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/07/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Single-organ vasculitis (SOV) is characterized by inflammation of a blood vessel, affecting one organ, such as the skin, genitourinary system, or the aorta without systemic features. Gastrointestinal SOV is rare, with hepatic artery involvement reported only in two prior published cases. Herein, we presented a case of isolated hepatic artery vasculitis presenting after Pfizer-BioNTech mRNA corona virus disease 2019 (COVID-19) vaccination.
CASE SUMMARY A 50-year-old woman with hypertension presented to our Emergency Department with recurrent diffuse abdominal pain that localized to the epigastrium and emesis without diarrhea that began eight days after the second dose of the Pfizer-BioNTech COVID-19 vaccine. Blood work revealed an elevated C-reactive protein (CRP) of 19 mg/L (normal < 4.8 mg/L), alkaline phosphatase 150 U/L (normal 25-105 U/L), gamma-glutamyl transferase (GGT) 45 U/L (normal < 43 U/L) and elevated immunoglobulins (Ig) G 18.4 g/L (normal 7-16 g/L) and IgA 4.4 g/L (normal 0.7-4 g/L). An abdominal computed tomography revealed findings in keeping with hepatic artery vasculitis. A detailed review of her history and examination did not reveal infectious or systemic autoimmune causes of her presentation. An extensive autoimmune panel was unremarkable. COVID-19 polymerase chain reaction nasopharyngeal swab, human immunodeficiency virus, viral hepatitis and Heliobacter pylori serology were negative. At six months, the patient’s symptoms, and blood work spontaneously normalized.
CONCLUSION High clinical suspicion of SOV is required for diagnosis in patients with acute abdominal pain and dyspepsia.
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Affiliation(s)
- Rojin Kaviani
- Internal Medicine, University of British Columbia, Vancouver V5Z 1M9, British Columbia, Canada
| | - Jessica Farrell
- Division of Radiology, Providence Health Care, Vancouver V5T 3N4, British Columbia, Canada
| | - Natasha Dehghan
- Division of Rheumatology, Providence Health Care, Vancouver V5T 3N4, British Columbia, Canada
| | - Sarvee Moosavi
- Division of Gastroenterology, University of British Columbia, Vancouver V6Z 2K5, British Columbia, Canada
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Ho JYK, Siu ICH, Ng KHL, Tam M, Chow SCY, Lim K, Kwok MWT, Wan S, Fujikawa T, Wong RHL. Retrospective record review on timing of COVID-19 vaccination and cardiac surgery. J Card Surg 2022; 37:3634-3638. [PMID: 36054404 PMCID: PMC9538689 DOI: 10.1111/jocs.16883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
Background Novel clinical challenges are faced by cardiac surgeons under the coronavirus disease 2019 (COVID‐19) pandemic. Amidst the uncertainties faced due to the socioeconomic and public health impact, there is little evidence surrounding COVID‐19 vaccination in patients undergoing cardiac surgery. Timing of vaccination and postvaccination adverse effects are required parameters to discuss with cardiac surgical patients. Methods This is a single‐center, retrospective observational study. All patients who underwent adult cardiac surgery at the Prince of Wales Hospital, Hong Kong from January 2021 to December 2021 were included. Postoperative clinical outcomes, COVID‐19 vaccination status, and vaccination‐related adverse effects were collected. Results A total of 426 patients; 117 (27%) underwent isolated coronary artery bypass grafting, 111 (26%) underwent valvular surgery, and 97 (23%) underwent aortic surgery. Patients received either Sinovac CoronaVac or Pfizer BNT162b2 vaccine. Overall vaccination rate with at least 1 dose was 52% (n = 212), 15% (n = 63) received the first dose before surgery, 36% (n = 149) received the first dose vaccination after surgery. Rate of completion with second and third doses of vaccination were 22% (n = 89) and 4.9% (n = 20), respectively. The mean timing of first dose of vaccine after surgery was 216 ± 84 days from operation. Three (1.4%) patients recorded vaccination‐related complications. Conclusions COVID‐19 vaccination is safe in patients who received major cardiac surgery, with low adverse effects recorded and no vaccine‐related mortality observed. A time frame of 3–6 months after cardiac surgery receiving COVID‐19 vaccination is reasonable and could serve as a guidance for future COVID‐19 vaccination booster programs.
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Affiliation(s)
- Jacky Y K Ho
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Ivan C H Siu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Karen H L Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Matthew Tam
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Simon C Y Chow
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Kevin Lim
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Micky W T Kwok
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Takuya Fujikawa
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Vidusa L, Kalejs O, Maca-Kaleja A, Strumfa I. Role of Endomyocardial Biopsy in Diagnostics of Myocarditis. Diagnostics (Basel) 2022; 12:diagnostics12092104. [PMID: 36140505 PMCID: PMC9497694 DOI: 10.3390/diagnostics12092104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
Endomyocardial biopsy as the cornerstone of diagnostics has been re-evaluated throughout the years, leaving unanswered questions on the precedence of it. The reported incidence of myocarditis has increased during the pandemic of coronavirus disease 2019 (COVID-19), reinforcing discussions on appropriate diagnostics of myocarditis. By analysis of evidence-based literature published within the last demi-decade, we aimed to summarize the most recent information in order to evaluate the current role of endomyocardial biopsy in diagnostics and management of myocarditis. For the most part, research published over the last five years showed ongoing uncertainty regarding the use, informativeness, safety and necessity of performing a biopsy. Special circumstances, such as fulminant clinical course or failure to respond to empirical treatment, were reconfirmed as justified indications, with a growing applicability of non-invasive diagnostic approaches for most other cases. We concluded that endomyocardial biopsy, if performed properly and with adjunct diagnostic methods, holds a critical role for treatment correction in specific histological subtypes of myocarditis and for differential diagnosis between immune-mediated myocarditis and secondary infections due to immunosuppressive treatment. A high level of possible misdiagnosing was detected, indicating the need to review terminology used to describe findings of myocardial inflammation that did not meet Dallas criteria.
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Affiliation(s)
- Liga Vidusa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
| | - Oskars Kalejs
- Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Aija Maca-Kaleja
- Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Correspondence:
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Acute Polyserositis with Cardiac Tamponade and Bilateral Refractory Pleural Effusion after ChAdOx1 nCoV-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10081286. [PMID: 36016174 PMCID: PMC9415510 DOI: 10.3390/vaccines10081286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
The association of SARS-CoV-2 messenger ribonucleic acid vaccines with pericarditis in young adults has been reported. However, data regarding other types of vaccines are extremely limited. We presented a 94-year-old man with rapidly progressive dyspnea and fatigue six days after his first ChAdOx1 nCoV-19 vaccination. Impending cardiac tamponade and bilateral pleural effusion were found. Hence, massive yellowish pericardial and pleural effusion were drained. However, the pleural effusion persisted and pigtail catheters were inserted bilaterally. After serial studies including surgical pleural biopsy, acute polyserositis (pericarditis and pleurisy) was diagnosed. Anti-inflammatory treatment with colchicine and prednisolone was administered. All effusions resolved accordingly. This rare case sheds light on the presentation of ChAdOx1 nCoV-19 vaccine-related acute polyserositis. In conclusion, awareness of this potential adverse event may facilitate the diagnosis for unexplained pericardial or pleural effusion after vaccination.
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Keshavarz P, Yazdanpanah F, Emad M, Hajati A, Nejati SF, Ebrahimian Sadabad F, Azrumelashvili T, Mizandari M, Raman SS. Myocarditis Following COVID-19 Vaccination: Cardiac Imaging Findings in 118 Studies. Tomography 2022; 8:1959-1973. [PMID: 36006062 PMCID: PMC9416085 DOI: 10.3390/tomography8040164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
We reviewed the reported imaging findings of myocarditis in the literature following COVID-19 vaccination on cardiac imaging by a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), and Google Scholar. In total, 532 cases of myocarditis after COVID-19 vaccination were reported (462, 86.8% men and 70, 13.2% women, age range 12 to 80) with the following distribution: Pfizer-BioNTech: 367 (69%), Moderna: 137 (25.8%), AstraZeneca: 12 (2.3%), Janssen/Johnson & Johnson: 6 (1.1%), COVAXIN: 1 (0.1%), and unknown mRNA vaccine: 9 (1.7%). The distribution of patients receiving vaccine dosage was investigated. On cardiac MR Imaging, late intravenous gadolinium enhancement (LGE) was observed mainly in the epicardial/subepicardial segments (90.8%, 318 of 350 enhancing segments), with the dominance of inferolateral segment and inferior walls. Pericardial effusion was reported in 13.1% of cases. The vast majority of patients (94%, 500 of 532) were discharged from the hospital except for 4 (0.7%) cases. Post-COVID-19 myocarditis was most commonly reported in symptomatic men after the second or third dose, with CMRI findings including LGE in 90.8% of inferior and inferolateral epicardial/subepicardial segments. Most cases were self-limited.
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Affiliation(s)
- Pedram Keshavarz
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (P.K.); (S.S.R.)
- School of Science and Technology, The University of Georgia, Tbilisi 0171, Georgia
| | - Fereshteh Yazdanpanah
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz 5166, Iran;
| | - Maryam Emad
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | - Azadeh Hajati
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | - Seyed Faraz Nejati
- Taba Medical Imaging Center, Shiraz 71347-53151, Iran; (M.E.); (A.H.); (S.F.N.); (F.E.S.)
| | | | - Tamta Azrumelashvili
- Department of Diagnostic & Interventional Radiology, New Hospitals Ltd., Tbilisi 0114, Georgia;
| | - Malkhaz Mizandari
- Department of Diagnostic & Interventional Radiology, New Hospitals Ltd., Tbilisi 0114, Georgia;
| | - Steven S. Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (P.K.); (S.S.R.)
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The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management. J Pers Med 2022; 12:jpm12081244. [PMID: 36013193 PMCID: PMC9410002 DOI: 10.3390/jpm12081244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both a consequence and a potential cause of TC. However, the precise pathophysiological mechanism linking the two conditions is still poorly understood. The aim of our review is to expand insights regarding the genetic susceptibility and available specific biomarkers of TC and to investigate the clinical profile and outcomes of patients with TC and stroke. Since evidence and trials on TC and stroke are currently lacking, this paper aims to fill a substantial gap in the literature about the relationship between these pathologies.
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Baronti A, Gentile F, Manetti AC, Scatena A, Pellegrini S, Pucci A, Franzini M, Castiglione V, Maiese A, Giannoni A, Pistello M, Emdin M, Aquaro GD, Di Paolo M. Myocardial Infarction Following COVID-19 Vaccine Administration: Post Hoc, Ergo Propter Hoc? Viruses 2022; 14:v14081644. [PMID: 36016266 PMCID: PMC9413746 DOI: 10.3390/v14081644] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccination against coronavirus disease 2019 (COVID-19) is the safest and most effective strategy for controlling the pandemic. However, some cases of acute cardiac events following vaccine administration have been reported, including myocarditis and myocardial infarction (MI). While post-vaccine myocarditis has been widely discussed, information about post-vaccine MI is scarce and heterogenous, often lacking in histopathological and pathophysiological details. We hereby present five cases (four men, mean age 64 years, range 50–76) of sudden death secondary to MI and tightly temporally related to COVID-19 vaccination. In each case, comprehensive macro- and microscopic pathological analyses were performed, including post-mortem cardiac magnetic resonance, to ascertain the cause of death. To investigate the pathophysiological determinants of MI, toxicological and tryptase analyses were performed, yielding negative results, while the absence of anti-platelet factor 4 antibodies ruled out vaccine-induced thrombotic thrombocytopenia. Finally, genetic testing disclosed that all subjects were carriers of at least one pro-thrombotic mutation. Although the presented cases do not allow us to establish any causative relation, they should foster further research to investigate the possible link between COVID-19 vaccination, pro-thrombotic genotypes, and acute cardiovascular events.
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Affiliation(s)
- Arianna Baronti
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Francesco Gentile
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
| | - Alice Chiara Manetti
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Andrea Scatena
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Angela Pucci
- Department of Histopathology, University of Pisa, 56126 Pisa, Italy;
| | - Maria Franzini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy;
| | - Vincenzo Castiglione
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Aniello Maiese
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Alberto Giannoni
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Mauro Pistello
- Retrovirus Center and Virology Section, Department of Translational Research, University of Pisa, 56126 Pisa, Italy;
| | - Michele Emdin
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence: or
| | | | - Marco Di Paolo
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
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Asaduzzaman M, Purkayastha B, Alam MMJ, Chakraborty SR, Roy S, Ahmed N. COVID-19 mRNA vaccine-associated encephalopathy, myocarditis, and thrombocytopenia with excellent response to methylprednisolone: A case report. J Neuroimmunol 2022; 368:577883. [PMID: 35561428 PMCID: PMC9080027 DOI: 10.1016/j.jneuroim.2022.577883] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/15/2022] [Accepted: 05/04/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Large-scale vaccination is considered one of the most effective strategies to control the pandemic of COVID-19. Since its start, different complications have been described thought to be related to vaccination. Here, we present a rare case where encephalopathy, myocarditis, and thrombocytopenia developed simultaneously following the second dose of Pfizer-BioNTech mRNA vaccine (BNT162b2). CASE PRESENTATION A 15-years-old female presented with fever, altered consciousness, and convulsions after taking the second shot of the vaccine. Clinical and laboratory workup was notable for the presence of thrombocytopenia and myocarditis. No alternative causes of encephalitis were found. The patient responded significantly to methylprednisolone suggesting underlying immune pathogenesis responsible for the clinical features. The diagnostic criteria for possible autoimmune encephalitis were also fulfilled. CONCLUSION Although rare, the clinician should be aware of the possible adverse events following COVID-19 vaccination. Further research with large pooled data is needed to get more insight into its pathogenesis and causal relationship.
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Affiliation(s)
- Md Asaduzzaman
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet 3100, Bangladesh.
| | - Bidrum Purkayastha
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet 3100, Bangladesh.
| | - M M Jahangir Alam
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet 3100, Bangladesh.
| | | | - Soumitra Roy
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet 3100, Bangladesh.
| | - Nasad Ahmed
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet 3100, Bangladesh.
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Khan Z, Pabani UK, Gul A, Muhammad SA, Yousif Y, Abumedian M, Elmahdi O, Gupta A. COVID-19 Vaccine-Induced Myocarditis: A Systemic Review and Literature Search. Cureus 2022; 14:e27408. [PMID: 36051715 PMCID: PMC9419896 DOI: 10.7759/cureus.27408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 01/15/2023] Open
Abstract
Myocarditis is one of the complications reported with COVID-19 vaccines, particularly both Pfizer-BioNTech and Moderna vaccines. Most of the published data about this association come from case reports and series. Integrating the geographical data, clinical manifestations, and outcomes is therefore important in patients with myocarditis to better understand the disease. A thorough literature search was conducted in Cochrane library, PubMed, ScienceDirect, and Google Scholar for published literature till 30 March 2022. We identified 26 patients eligible from 29 studies; the data were pooled from these qualifying case reports and case series. Around 94% of patients were male in this study, the median age for onset of myocarditis was 22 years and 85% developed symptoms after the second dose. The median time of admission for patients to hospitals post-vaccination was three days and chest pain was the most common presenting symptom in these patients. Most patients had elevated troponin on admission and about 90% of patients had cardiac magnetic resonance imaging (CMR) that showed late gadolinium enhancement. All patients admitted with myocarditis were discharged home after a median stay of four days. Results from this current analysis show that post-mRNA vaccination myocarditis is mainly seen in young males after the second dose of vaccination. The pathophysiology of vaccine-induced myocarditis is not entirely clear and late gadolinium enhancement is a common finding on CMR in these patients that may indicate myocardial fibrosis or necrosis. Prognosis remains good and all patients recovered from myocarditis, however further studies are advisable to assess long-term prognosis of myocarditis.
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Affiliation(s)
- Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR.,Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR.,Cardiology, Royal Free Hospital, London, GBR
| | - Umesh Kumar Pabani
- Internal Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Amresh Gul
- General Practice, Starcare Hospital, Duqm, OMN
| | - Syed Aun Muhammad
- Cardiology, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR
| | - Yousif Yousif
- Internal Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Mohammed Abumedian
- Geriatrics, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Ola Elmahdi
- Internal Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, GBR
| | - Animesh Gupta
- Acute Internal Medicine, Southend University Hospital, Southend on Sea, GBR.,Acute Internal Medicine and Intensive Care, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
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50
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Elseidy SA, Awad AK, Vorla M, Fatima A, Elbadawy MA, Mandal D, Mohamad T. Cardiovascular complications in the Post-Acute COVID-19 syndrome (PACS). IJC HEART & VASCULATURE 2022; 40:101012. [PMID: 35355927 PMCID: PMC8958273 DOI: 10.1016/j.ijcha.2022.101012] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 01/08/2023]
Abstract
The presence of stress-related (Takotsubo) cardiomyopathy has also been demonstrated in COVID-19. The proposed mechanisms of cardiac damage during the acute phase of COVID-19 include both direct -viral penetration- and indirect routes -hypoxic injury and systemic inflammation. SARS-CoV-2 infection, especially in its severe form, is associated with an increased risk for venous thromboembolism (VTE). Unfractionated heparin (UFH) is the first-line treatment for hemodynamic instability and emergency reperfusion for PASC. Further studies are needed to offer current screening for the occurrence of cardiovascular problems especially myocardial infarction and heart failure in COVID-19 patients.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) or coronavirus disease 2019 (COVID-19) initially surfaced in December 2019 from Wuhan, China, sweeping the world with various strains, forcing the WHO to declare a pandemic epidemic in March 2020. Furthermore, COVID-19 manifests with a wide array of presentations from fever and fatigue to severe respiratory and cardiovascular complications. Post-COVID-19 syndrome is poorly understood affecting COVID-19 survivors at all levels of disease severity. The disease is most associated with post-discharge dyspnea and fatigue. However, other persistent symptoms as chest pains, palpitations, smell, and taste dysfunctions. Patients with high concentrations of CRP and creatinine in the acute phase of Covid-19 are more prone to cardiac sequelae. Therefore, high levels of cardiac-sensitive troponin and hypokalaemia can also be used for risk stratification. Furthermore, Cardiac damage can manifest as myocarditis, pericarditis, rhythm abnormalities. The use of different diagnostic modalities like electrocardiogram (ECG), echocardiogram, and cardiac magnetic resonance imaging (MRI)(CMR) to evaluate the myocardial damage were studied. However, Cardiovascular complications are a common manifestation of PASC, classification of severity of cardiac symptoms and the emergence of CMR as a diagnostic tool needs more evidence.
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Key Words
- ACE2, Angiotensin-converting enzyme 2
- CAMKII, calmodulin-dependent protein kinase II
- CMR, Cardiac magnetic resonance imaging
- COVID-19
- COVID-19, Coronavirus disease 2019
- CVD, Cardiovascular disease
- Cardiovascular diseases
- DAMPs, damage-associated molecular patterns
- IL, interleukin
- Myocardial infarction
- NOAC, novel oral anticoagulation
- PACS, Post-Acute COVID-19 syndrome
- Post covid sequelae
- RAAS, Renin-Angiotensin Aldosterone System dysregulation
- SARS-CoV 2, severe acute respiratory syndrome coronavirus 2
- TMPRS2, transmembrane protease serine 2
- TNF-Alpha, Tumor necrosis factor-alpha
- TTE, transthoracic echocardiogram
- UFH, Unfractionated heparin
- VTE, venous thromboembolism
- WHO, World health organization
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Affiliation(s)
- Sheref A Elseidy
- Internal medicine department, University of Texas health sciences, Houston, TX
| | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Monica Vorla
- Department of internal medicine, University of Louisville School of Medicine, Louisville, Ky
| | - Amina Fatima
- University of Louisville School of Medicine, Louisville, Ky
| | | | | | - Tamam Mohamad
- Cardiovascular Disease Department, Wayne State University, Detroit, MI
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