Shaheen Nour, Ramadan Abdelraouf, Shaheen Ahmed, Elmasry Mohamed, Swed Sarya, Hafez Wael, Wael Muhannad
Faculty of Medicine, Alexandria University, Alexandria, EGY.
Faculty of Medicine, Cairo University, Cairo, EGY.
Cureus. 2023 Apr 22;15(4):e37999. doi: 10.7759/cureus.37999. eCollection 2023 Apr.
COVID-19 vaccination has significantly reduced both the morbidity and mortality rates associated with SARS-CoV-2 infection. Vaccines, especially mRNA vaccines, have been proposed in several studies to complicate viral myocarditis. Thus, our systematic and meta-analysis review aims to further investigate the possibility of an association between COVID-19 vaccines and myocarditis. We systematically searched PubMed, Web of Science, Scopus, Ovid, and Google Scholar and did a gray search of other databases using the following keywords and terms: "Myocarditis ("Myocarditis" Mesh) OR "Chagas Cardiomyopathy" Mesh) AND "COVID-19 Vaccines" Mesh. The studies were limited to only English articles that reported myocardial inflammation or myocarditis associated with COVID-19 vaccines. Pooled risk ratio with its 95% confidence interval was analyzed by RevMan software (5.4) to perform the meta-analysis. Our study included 671 patients from 44 studies with a mean age of 14-40 years. Nevertheless, myocarditis was noted in a mean of (3.227) days, and 4.19 per million vaccination recipients experienced myocarditis. Most cases were clinically presented with manifestations of cough, chest pain, and fever. Laboratory tests revealed increased C-reactive protein, and troponin with all other cardiac markers in most patients. Cardiac magnetic resonance imaging (MRI) revealed late gadolinium enhancement with myocardial edema and cardiomegaly. Also, electrocardiograms revealed ST-segment elevation in most patients. Furthermore, the incidence of myocarditis was statistically significantly lower in the COVID-19 vaccine group as compared with the control group (RR = 0.15, 95% CI = 0.10-0.23, p-value < 0.00001). No significant association was found between COVID-19 vaccines and the incidence of myocarditis. The study's findings highlight the importance of implementing evidence-based COVID-19 prevention strategies, such as vaccination, to reduce the public health impact of COVID-19 and its associated complications.
新冠病毒疫苗接种显著降低了与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染相关的发病率和死亡率。在多项研究中，有人提出疫苗，尤其是信使核糖核酸（mRNA）疫苗，会使病毒性心肌炎复杂化。因此，我们的系统评价和荟萃分析旨在进一步研究新冠病毒疫苗与心肌炎之间存在关联的可能性。我们系统检索了PubMed、科学网、Scopus、Ovid和谷歌学术，并使用以下关键词和术语对其他数据库进行了灰色文献检索：“心肌炎（“心肌炎”[医学主题词（Mesh）]或“恰加斯心肌病”[Mesh]）与“新冠病毒疫苗”[Mesh]”。纳入的研究仅限于报告与新冠病毒疫苗相关的心肌炎症或心肌炎的英文文章。使用RevMan软件（5.4）分析合并风险比及其95%置信区间以进行荟萃分析。我们的研究纳入了来自44项研究的671名患者，平均年龄为14至40岁。然而，心肌炎平均在（3.227）天被发现，每百万疫苗接种者中有4.19人发生心肌炎。大多数病例临床上表现为咳嗽、胸痛和发热。实验室检查显示大多数患者的C反应蛋白、肌钙蛋白以及所有其他心脏标志物升高。心脏磁共振成像（MRI）显示钆延迟强化伴有心肌水肿和心脏扩大。此外，大多数患者的心电图显示ST段抬高。此外，与对照组相比，新冠病毒疫苗组心肌炎的发病率在统计学上显著更低（风险比=0.15，95%置信区间=0.10-0.23，P值<0.00001）。未发现新冠病毒疫苗与心肌炎发病率之间存在显著关联。该研究结果凸显了实施基于证据的新冠病毒预防策略（如接种疫苗）对于减少新冠病毒及其相关并发症对公众健康影响的重要性。
