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Heart problems after COVID infection and vaccination: new data

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New data from two different sources on cardiac complications from COVID-19 have shown that these problems are low overall, but higher after infection than after vaccination.

The new information comes from the Centers for Disease Control and Prevention (CDC) National Patient-Centered Clinical Research Network (PCORnet) and a separate large international clinical study published online in Traffic April 11.

CDC data

The CDC study analyzed electronic health record data from 40 U.S. health systems from January 1, 2021 through January 31, 2022, on more than 15 million people aged 5 or older.

It reports a rate of myocarditis or pericarditis after COVID-19 mRNA vaccination of 0 to 35.9 per 100,000 for men and 0 to 10.9 per 100,000 for women in different age groups and cohorts. of vaccines.

Rates of myocarditis or pericarditis after SARS-CoV-2 infection ranged from 12.6 to 114 per 100,000 for men and from 5.4 to 61.7 per 100,000 for women in different age groups. age.

Even among men aged 12 to 17, the group with the highest incidence of heart complications after receiving a second dose of the COVID-19 mRNA vaccine, the risk was 1.8 to 5.6 times higher after the infection with SARS-CoV-2 only after vaccination, the CDC report notes.

“These results provide important context for balancing the risks and benefits of COVID-19 mRNA vaccination in eligible individuals ≥5 years of age,” the report states. They also “support continued use of recommended mRNA vaccines in all eligible individuals ≥5 years of age,” he concludes.

International study

The international study focused on the prevalence, clinical characteristics and outcomes of clinically manifest acute myocarditis in patients infected with COVID-19.

The study showed an acute myocarditis rate of 2.4 per 1,000 patients hospitalized with COVID-19.

“A small study has previously indicated that acute myocarditis is a rare event in people infected with COVID-19. Our analysis of international data offers greater insight into the occurrence of acute myocarditis during COVID-19 hospitalization, particularly before COVID-19 vaccines became widely available. “, commented co-author, Enrico Ammirati, MD, PhD, Niguarda Hospital, Milan, Italy.

“This analysis indicates that, although rare, hospitalized patients with acute myocarditis associated with COVID-19 infection have a much greater need for intensive care unit admission, up to 70.5% of cases, despite the average age of individuals in the study being much younger than expected at 38,” added co-author Marco Metra, MD, University of Brescia, Italy.

The researchers report that the use of corticosteroids in patients with acute myocarditis appeared to be safe, and in most cases a rapid increase in left ventricular ejection fraction was observed. Additionally, they say that discharged patients with acute myocarditis had “an excellent short-term prognosis with no occurrence of cardiovascular events.”

The authors also point out that these data show a much higher frequency and severity of acute myocarditis linked to COVID-19 infection compared to cases of myocarditis linked to COVID-19 mRNA vaccines.

The international study looked at health data from 56,963 patients hospitalized with COVID-19 at 23 hospitals in the United States and Europe from February 2020 to April 2021.

Of these patients, 97 with possible acute myocarditis were identified (4.1 per 1000), of whom 54 (2.4 per 1000) were classified as having “definite or probable” acute myocarditis supported by endomyocardial biopsy (31 .5% of cases) or magnetic resonance imaging. (92.6% of cases).

The median age of definite/probable acute myocarditis cases was 38 years, and 39% were female. On admission, chest pain and dyspnea were the most common symptoms (55.5% and 53.7%, respectively), and 31 cases (57.4%) occurred in the absence of pneumonia associated with the COVID-19. A fulminant presentation requiring inotropic support or temporary mechanical circulatory support occurred in 21 cases (39%).

In total, 38 patients (70.4%) were admitted to intensive care for a median duration of 6 days. Ten patients (18.5%) received temporary mechanical circulatory support for a median of 5 days. Three patients died (5.5%) during the index hospitalization, all of whom also had pneumonia. At 120 days, the estimated mortality was 6.6%. Patients with pneumonia were more likely to develop hemodynamic instability, require mechanical circulatory support, and die, compared to those without pneumonia.

The authors note that their reported prevalence of acute myocarditis associated with COVID-19 is lower than that of studies that performed universal cardiac MRI screening during the COVID-19 recovery period.

They say underestimation of the prevalence of mild or subclinical acute myocarditis is likely in this study due to the retrospective nature of the registry, the lack of routine cardiac MRI, and the possibility of missing some diagnoses, in particularly during the first pandemic wave when MRI and endomyocardial biopsy were performed less frequently.

The authors also point out that data on myocarditis after COVID-19 vaccination suggest that vaccination-related myocarditis is milder than that associated with the virus itself.

Regarding the prevalence of acute myocarditis after vaccination, they report that among 2.8 million doses of COVID-19 mRNA vaccine in the armed forces, 23 people showed signs of acute myocarditis, suggesting a prevalence of less than 1 cases of acute myocarditis per 100,000 Doses of COVID-19 mRNA vaccine.

They note that the CDC has also reported 399 reports of myocarditis among 129 million people fully vaccinated with COVID-19 mRNA vaccines.

“These numbers seem reassuring when compared to the prevalence of clinically overt acute myocarditis observed in this study among hospitalized patients with COVID-19,” they conclude.

MMWR Morb Mortal Wkly Rep. Published online April 8, 2022. Full text.

Traffic. Published online April 11, 2022. Summary.

This study was funded by a grant from the Italian Ministry and the Registry of Cardio-Cerebrovascular Pathology, Veneto Region, Venice, Italy.

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