Lesión Miocárdica posterior a vacunación de refuerzo Covid-19 mRNA-1273 (Hospital Universitario de Basilea)

 

 

 

 Natacha Buergin 1*, Pedro Lopez-Ayala1*, Julia R. Hirsiger2 , Philip Mueller1 , Daniela
Median1 , Noemi Glarner 1 , Klara Rumora1 , Timon Herrmann 1 , Luca Koechlin 1 , Philip Haaf1 ,
Katharina Rentsch3 , Manuel Battegay4 , Florian Banderet 5,6 , Christoph T. Berger2,7 , Christian
Mueller1
1 Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University
Hospital Basel, University of Basel, Basel; 2 Department of Biomedicine, Translational
Immunology, University of Basel, Basel; 3 Department of Laboratory Medicine, University
Hospital Basel, University of Basel, Basel; 4 Department of Infectious diseases & Hospital
Epidemiology , University Hospital Basel, University of Basel, Basel; 5 Department of Internal
Medicine, Medical Outpatient Unit, University Hospital Basel, Basel; 6 Employee health
service, University Hospital Basel, Basel Switzerland, 7 University Center for Immunology,
University Hospital Basel, Basel

 Buergin Natacha (Orcid ID: 0000-0001-6436-0054)
Abstract (246, maximum 250 words)

Aims: To explore the incidence and potential mechanisms of oligosymptomatic myocardial
injury following COVID-19 mRNA booster vaccination.

Methods and Results: Hospital employees scheduled to undergo mRNA-1273 booster vaccination were assessed for mRNA-1273 vaccination-associated myocardial injury, defined as acute dynamic increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration above the sex-specific upper-limit of normal on day 3 (48-96h) after vaccination without evidence ofan alternative cause. To explore possible mechanisms, antibodies against IL-1RA, the SARS-CoV2-Nucleoprotein(NP) and -Spike(S1) proteins and an array of 14 inflammatory cytokines were quantified. Among 777 participants, median age 37 years, 69.5% women, 40 participants (5.1% [95%CI, 3.7-7.0%]) had elevated hs-cTnT concentration on day 3 and mRNA-1273 vaccine-associated myocardial injury was adjudicated in 22 participants (2.8% [95%CI, 1.7-4.3%]). Twenty cases occurred in women (3.7% [95%CI, 2.3-5.7%]), two in men (0.8% [95%CI, 0.1-3.0%]). Hs-cTnT-elevations were mild and only temporary. No patient had ECG- changes, and none developed major adverse cardiac events within 30 days (0% [95%CI, 0-0.4%]). In the overall booster cohort, hs-cTnT concentrations (day 3; median 5 [IQR, 4-6] ng/L)were significantly higher compared to matched controls (n=777, median 3 [IQR, 3-5] ng/L,p<0.001). Cases had comparable systemic reactogenicity, concentrations of anti-IL-1RA, anti-NP, anti-S1, and markers quantifying systemic inflammation, but lower concentrations of IFN-λ1(IL-29) and GM-CSF versus persons without vaccine-associated myocardial injury.

Conclusion: mRNA-1273 vaccine-associated myocardial injury was more common than
previously thought, being mild and transient, and more frequent in women versus men.

 Therefore, the main finding of this study, that subclinical mRNA vaccine-associated myocardial injury is much more common than estimated based on passive surveillance, has
been confirmed and generalized in these complimentary cohorts of slightly older health care
workers in Israel and adolescents in Thailand. Additional active surveillance studies are needed to externally validate two specific findings of this study: the even higher rate of mRNA-1273 booster vaccination associated myocardial injury overall, and particularly in women.

In conclusion, using active surveillance, mRNA-1273 vaccine-associated mild transient myocardial injury was found to be much more common than previously thought. It occurred in one out of 35 persons, was mild and transient, and more frequent in women versus men. Neitheranti-IL-1RA, nor pre-existing vaccine/infection-induced immunity or systemic inflammation seemed to be dominant mechanisms of myocardial injury.