Echocardiographic function evaluation in adolescents following BNT162b2 Pfizer-BioNTech mRNA vaccination: A preliminary prospective study

Abstract

Background: Vaccination against coronavirus disease 2019 (COVID-19) is crucial for preventing and minimizing illness. Myocarditis and pericarditis after mRNA COVID-19 vaccination in adolescents and young adult males have been reported. Most of the studies in this area rely on retrospective symptom reporting, especially for adolescents experiencing myocarditis as a potential side effect. However, prospective post-vaccination echocardiographic evaluation is rare. Methods: The study enrolled adolescents aged 12 to 15 years who received the second dose of the BNT162b2 mRNA-Pfizer-BioNTech vaccine (BNT vaccine). Serial echocardiographic examinations were conducted at baseline before vaccination, followed by subsequent assessments on days 2, 7, 14, and 28 to identify any notable differences or abnormal changes in cardiac function. Clinical symptom assessments were also recorded during each follow-up. Results: The study included 25 adolescents, comprising 14 males and 11 females, who completed the four follow-ups. Their mean age was 14 ± 1 years. The average interval between the first and second BNT vaccine doses was 90 ± 7 days. Ejection fraction values were 73.8% ± 5.2% at baseline and 75.7% ± 5.2% at subsequent assessment time points (75.5% ± 4.6%, 75.7% ± 4.5%, 75.79% ± 4.5%, and 77.8% ± 5.9% at day 2, 7, 14, and 28, respectively). The cardiac function remained stable across all time points, with no significant differences observed between male and female participants. Within post-vaccination 48 hours, 18 (72%) of the enrolled adolescents experienced temporary discomfort symptoms, which completely resolved by the final follow-up on the 28th day after vaccination. Conclusion: Although adolescents vaccinated with the second dose of BNT vaccine commonly experienced transient post-vaccination discomfort, the serial echocardiographic examinations did not reveal any significant deterioration of cardiac function within 28 days. Further studies are required to investigate the incidence of SARS-CoV-2 mRNA vaccination-associated myocarditis in adolescents and the related mechanisms.

To conclude that BNT162b2 does not worsen echocardiographic indices, well-powered multicenter studies are required

“…1 Likewise, fractional shortening increased from 42.4% at baseline to 46.7% on day 28 postvaccination. 1 In females (n = 11), left ventricular assist devices (LVIDs) decreased from baseline to day 2 postvaccination. 1 It was concluded that adolescents vaccinated with BNT162b2 often experience transient discomfort after the second dose, but serial echocardiography does not detect significant deterioration until day 28 postvaccination.…”

“…Serial echocardiographic examinations were performed on days −7, 2, 7, 14, and 28 before/after vaccination. 1 Ejection fraction increased from 73.8% at baseline to 77.8 on day 28. 1 Likewise, fractional shortening increased from 42.4% at baseline to 46.7% on day 28 postvaccination.…”

“…1 Ejection fraction increased from 73.8% at baseline to 77.8 on day 28. 1 Likewise, fractional shortening increased from 42.4% at baseline to 46.7% on day 28 postvaccination. 1 In females (n = 11), left ventricular assist devices (LVIDs) decreased from baseline to day 2 postvaccination.…”

“…We read with interest Hsu et al’s 1 article on the echocardiographic findings in 25 adolescent vaccinees who received the second dose of the BNT162b2 vaccine. Serial echocardiographic examinations were performed on days −7, 2, 7, 14, and 28 before/after vaccination.…”

“…1 In females (n = 11), left ventricular assist devices (LVIDs) decreased from baseline to day 2 postvaccination. 1 It was concluded that adolescents vaccinated with BNT162b2 often experience transient discomfort after the second dose, but serial echocardiography does not detect significant deterioration until day 28 postvaccination. 1 The study is impressive, but some points require discussion.…”