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新型冠状病毒疫苗的心血管并发症:病例报告和病例系列研究综述。

Cardiovascular complications of COVID-19 vaccines: A review of case-report and case-series studies.

机构信息

Cardiologist, Cardiology Department, Chamran Cardiovascular Medical and Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

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.

出版信息

Heart Lung. 2023 May-Jun;59:173-180. doi: 10.1016/j.hrtlng.2023.02.003. Epub 2023 Feb 8.

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.

摘要

背景

有多项关于 COVID-19 疾病对不同人群心血管系统影响的综述,但缺乏关于 COVID 疫苗心血管不良影响的证据。

目的

本研究旨在比较 COVID19 疫苗的心脏并发症,根据疫苗类型(mRNA、基于载体和灭活疫苗)进行比较。

方法

系统检索 PubMed 上的英文病例报告和病例系列研究,最终纳入 100 项研究。

结果

心肌炎(总体发生率约为 1.62%)是 COVID 后免疫接种后最常见的心脏事件。超过 90%的 COVID 后疫苗接种心肌炎发生在接受 mRNA 疫苗(Moderna 和 Pfizer-BioNTech)后,但基于载体的疫苗和/或灭活疫苗的报告较少。心肌炎更常见于男性,且发生在接种第二剂疫苗后。Takotsubo 心肌病(TTC)在 mRNA(更常见)和基于载体的疫苗接种后报告,但在灭活疫苗后没有报告。当使用 mRNA 和基于载体的疫苗接种代替灭活疫苗时,报告的疫苗诱导的血栓性血小板减少症(VITT)和肺栓塞(PE)的频率更高。心肌梗死/心脏骤停发生在 75 岁以上的人群中。

结论

COVID-19 疫苗接种对个人和公共健康的益处远远超过轻微的心脏风险。报告偏倚,关于发达国家更可获得的 mRNA 疫苗,可能会与这些结果相冲突。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7008/9905103/c8d2569e6f2b/gr1_lrg.jpg

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