A 39-year-old male was admitted in the emergency room with chest pain. He had been given the second dose of Pfizer–BioNTech COVID-19 vaccine 3 days before. The patient denied taking any other medication beyond the usual. He didn’t feel sick in the previous days/weeks. Laboratory studies revealed elevated serum levels of troponin and C-reactive protein. An autoantibody screen and a serologic panel to detect common viruses were negative. A cardiac MRI showed myocardial edema/inflammation and confirmed the diagnosis of perimyocarditis which was considered to be a consequence of COVID-19 vaccination. Physicians should be aware of the possibility of cardiovascular complications after COVID-19 vaccination.

A morte súbita cardíaca (MSC) em adultos jovens (18-35 anos) é causada mais frequentemente de cardiomiopatias hereditárias previamente não diagnosticadas. As causas mais comuns de MSC são a cardiomiopatia hipertrófica e a cardiomiopatia arritmogênica (CMA), seguidas de anomalias congênitas das artérias coronárias, miocardite, ruptura aórtica na síndrome de Marfan, defeitos de condução, e doenças valvulares. 1 ReferênciasEste é um artigo de acesso aberto distribuído sob os termos da licença de atribuição pelo Creative Commons Potencial conflito de interesse Não há conflito com o presente artigo Fontes de financiamentoO presente estudo não teve fontes de financiamento externas. Vinculação acadêmicaNão há vinculação deste estudo a programas de pós-graduação. Aprovação ética e consentimento informadoEste artigo não contém estudos com humanos ou animais realizados por nenhum dos autores.

Funding Acknowledgements Type of funding sources: None. Background Chemotherapy, in particular anthracyclines (A) and trastuzumab (T), have improved disease-free survival and overall prognosis in patients with breast cancer (BC). The use of these two different types of agents may increase myocardial injury and cancer therapy-related cardiac dysfunction (CTRCD). CTRCD is defined as a reduction of left ventricular ejection fraction (LVEF) >10% to a value <50% or as a relative reduction of global longitudinal strain (GLS) >15%. However, the role of diastolic dysfunction has been insufficiently researched. Purpose We sought to evaluate the impact of cardiotoxic treatments on left ventricular diastolic function. Methods Retrospective study of patients with first non-metastatic BC treated with A and/or T between Jan 2017 and Dec 2018 who underwent a comprehensive echocardiographic examination before, during, and after chemotherapy. We evaluated parameters of diastolic function derived from pulsed wave doppler interrogation of the mitral valve inflow (E/A ratio and mitral E-wave deceleration time (EDT)) and tissue doppler (E/E’ ratio). Results We included 128 patients, all female with median age of 54±11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%). At the end of A therapy, E/A ratio (p=0,056), EDT (p=0,156) and E/E’ ratio (p=0,319) and left atrial volume index (LAVI) (p=0,056) did not show significant changes. At 2 years of follow-up, these parameters did not differ compared to baseline. During T therapy, diastolic parameters did not differ from baseline. At the end of T therapy (with or without A), E/E’ ratio had a statistically significant increase (8,61±2,61 vs 9,70±3,59, p<0,05) but no changes in EDT (p=0,461) or E/A ratio (p=0,464) occurred. At 2 years of follow-up, EDT had a statistically significant increase (204,90±44,24 vs 229,10±58,53, p<0,05) but no changes in E/A ratio (p=0,476) or E/E’ ratio (p=0,499) occurred. Conclusion In our sample of women with BC who underwent chemotherapy, early significant changes in diastolic parameters did not occur. One parameter of diastolic dysfunction was changed at 2 years of follow-up. In this study, BC chemotherapy has a very modest impact on LV diastolic function. Randomized studies on larger population are required. Other parameters should be considered to determine the diagnostic and prognostic role of LV diastolic function in CTRCD.

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