Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
Rev Med Virol. 2022 Jul;32(4):e2318. doi: 10.1002/rmv.2318. Epub 2021 Dec 17.
There have been several local and systemic adverse events associated with mRNA COVID-19 vaccines. Pericarditis, myocarditis and myocardial infarction are examples of cardiac complications related to these vaccines. In this article, we conducted a systematic review of case reports and case series to identify the clinical profile, investigations, and management of reported cardiac complications post-mRNA COVID-19 vaccines. We systematically searched PubMed, Scopus, Web of Science, and Google Scholar, as well as the medRxiv preprint server, with terms including: 'SARS-CoV-2', 'COVID-19', 'messenger RNA vaccine*', 'mRNA-1273 vaccine', 'BNT162 vaccine', 'myocarditis', 'pericarditis', 'stroke' and 'Myocardial Ischemia' up to 25 September 2021. Studies were excluded if they were not case reports or case series, or reported cases from non-mRNA vaccines. Case reports and case series were included that investigated the potential cardiac complications associated with mRNA COVID-19 vaccines. The JBI checklist was used to assess quality and data synthesis was conducted using a qualitative methodology called narrative synthesis. Sixty-nine studies, including 43 case reports and 26 case series, were included. Myocarditis/myopericarditis and pericarditis were the most common adverse events among the 243 reported cardiac complications, post mRNA COVID-19 vaccination. Males with a median age of 21 years had the highest frequency of myocarditis. Almost three quarters (74.4%) of cases with myocarditis had received the BNT162b2 vaccine and 87.7% had received the second dose of the vaccine. Chest pain (96.1%) and fever (38.2%) were the most common presentations. CK-MB, troponin, and NT-proBNP were elevated in 100%, 99.5% and 78.3% of subjects, respectively. ST-segment abnormality was the most common electrocardiogram feature. Cardiac magnetic resonance imaging, which is the gold-standard approach for diagnosing myocarditis, was abnormal in all patients diagnosed with myocarditis. Non-steroidal anti-inflammatory drugs were the most prescribed medication for the management of myocarditis. Apart from inflammatory conditions, some rare cases of Takotsubo cardiomyopathy, myocardial infarction, myocardial infarction with non-obstructive coronary arteries, and isolated tachycardia were also reported following immunisation with mRNA COVID-19 vaccines. We acknowledge that only reviewing case reports and case series studies is one potential limitation of our study. We found that myocarditis was the most commonly reported adverse cardiac event associated with mRNA COVID-19 vaccines, which presented as chest pain with a rise in cardiac biomarkers. Further large-scale observational studies are recommended.
已经有一些与 mRNA COVID-19 疫苗相关的局部和全身不良事件。心包炎、心肌炎和心肌梗死是与这些疫苗相关的心脏并发症的例子。在本文中,我们对病例报告和病例系列进行了系统回顾,以确定报告的 mRNA COVID-19 疫苗接种后心脏并发症的临床特征、检查和管理。我们系统地检索了 PubMed、Scopus、Web of Science 和 Google Scholar,以及 medRxiv 预印本服务器,使用的术语包括:“SARS-CoV-2”、“COVID-19”、“信使 RNA 疫苗*”、“mRNA-1273 疫苗”、“BNT162 疫苗”、“心肌炎”、“心包炎”、“中风”和“心肌缺血”,截至 2021 年 9 月 25 日。如果研究不是病例报告或病例系列,或者报告的病例来自非 mRNA 疫苗,则将其排除在外。纳入了调查与 mRNA COVID-19 疫苗相关潜在心脏并发症的病例报告和病例系列。使用 JBI 清单评估质量,并使用称为叙事综合的定性方法进行数据综合。共纳入 69 项研究,包括 43 份病例报告和 26 份病例系列。在报告的 243 例心脏并发症中,心肌炎/心肌心包炎和心包炎是最常见的不良事件。中位年龄为 21 岁的男性患心肌炎的频率最高。几乎四分之三(74.4%)的心肌炎病例接种了 BNT162b2 疫苗,87.7%的病例接种了第二剂疫苗。胸痛(96.1%)和发热(38.2%)是最常见的表现。CK-MB、肌钙蛋白和 NT-proBNP 分别在 100%、99.5%和 78.3%的受试者中升高。ST 段异常是最常见的心电图特征。心脏磁共振成像(诊断心肌炎的金标准方法)在所有诊断为心肌炎的患者中均异常。非甾体抗炎药是治疗心肌炎最常开的药物。除炎症外,一些罕见的 Takotsubo 心肌病、心肌梗死、非阻塞性冠状动脉心肌梗死和孤立性心动过速也有报道在接种 mRNA COVID-19 疫苗后发生。我们承认,仅审查病例报告和病例系列研究是我们研究的一个潜在局限性。我们发现心肌炎是与 mRNA COVID-19 疫苗相关的最常见报告的心脏不良事件,表现为胸痛伴心肌生物标志物升高。建议进一步开展大规模观察性研究。
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