Cardiac complications following mRNA COVID‐19 vaccines: A systematic review of case reports and case series

Abstract

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

A rare case of COVID-19 vaccine-induced myopericarditis in a young adult

“…The majority of reported cases had increased troponin (99.5% of cases), white blood cells, C-reactive protein levels (90.1% of cases), and diffuse ST-segment elevation on ECG, as observed in this case. While transthoracic echocardiogram showed normal left ventricular ejection fraction (LVEF) in most cases, 38 cases reported LVEF<50%, and only 10 cases reported minimal or mild pericardial effusion [5] . Although myopericarditis, in this case, manifested with normal ejection fraction (65%), it also showed moderate pericardial effusion of up to 1.4 cm that is not observed in other reported cases with LVEF>50% [5] .…”

“…Acute pericarditis is the presence of 2 or more pleuro-pericarditis chest pain, diffuse ST elevation, PR depression on electrocardiogram, pericardial effusion, or pericardial friction rub on the exam. Moreover, the diagnostic evaluation algorithm for myopericarditis requires an additional feature involving elevated cardiac biomarkers, left ventricular systolic dysfunction, or myocardial inflammation confirmed by cardiac magnetic resonance [5] . Despite the existence of rare cases of vaccine-induced myopericarditis and pericarditis, the benefit-risk assessment of the COVID-19 vaccine indicates a greater benefit regarding vaccine administration for all age and sex groups [5] .…”

“…Moreover, the diagnostic evaluation algorithm for myopericarditis requires an additional feature involving elevated cardiac biomarkers, left ventricular systolic dysfunction, or myocardial inflammation confirmed by cardiac magnetic resonance [5] . Despite the existence of rare cases of vaccine-induced myopericarditis and pericarditis, the benefit-risk assessment of the COVID-19 vaccine indicates a greater benefit regarding vaccine administration for all age and sex groups [5] . Manifestation of rare side effects resulting from the COVID-19 vaccine should raise awareness and highlight the importance of emergent medical care regarding potential life-threatening vaccine adverse effects.…”

Acute Pericarditis Post mRNA-1273 COVID Vaccine Booster

“…The majority (92%) were males, and the mean age was 21 years (range, 12-70 years). Three-quarters of the patients who were diagnosed with myocarditis or pericarditis had received the BNT162b2 vaccine (Pfizer-BioNTech), and most (88%) were diagnosed after the second vaccine dose, with a median time from immunization to symptom onset of three days (range: 1.5 hours to 73 days) [ 8 ].…”

Stress-Induced Cardiomyopathy—Considerations for Diagnosis and Management during the COVID-19 Pandemic

“…It is not clear, however, why high incidence of TTS has been reported during specific infections other than SARS-CoV-2, particularly influenza virus infection [42][43][44][45][46][47]. Moreover, TTS cases have been reported also following COVID-19 vaccinations [48]. It should be noted that disease-induced stress and catecholamine surge may also aggravate these pathways, and such an overlap in mechanisms seems reasonable.…”