Cardiovascular Manifestation of the BNT162b2 mRNA COVID-19 Vaccine in Adolescents
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Diary Card
2.3. Definition of Cardiovascular Manifestation
- Chest pain/pericarditis
- Dyspnea/orthopnea
- Palpitation
- Hypertension/hypotension
- Tachycardia/bradycardia
- Shock/cardiogenic shock
- Abnormal ECG or abnormal rhythm or ECG change
- Bundle branch block
- Decreased ejection fraction
- Diastolic dysfunction
- Elevation in at least one cardiac biomarker (troponin-T, CK-MB)/myocarditis
2.4. Definition of Myocarditis [18]
2.5. Definition of Pericarditis [18]
2.6. Cardiac Enzymes
2.7. Echocardiography Protocol
2.8. Sample Size Calculation
2.9. Statistical Analysis
3. Results
3.1. Characteristics of the Study Population
3.2. Cardiovascular Findings
3.3. Evaluation of Patients with Elevated Biomarkers or Positive Lab Assessments
3.4. Evaluation of Patients Developing Abnormal ECG Post-Vaccination
3.5. Evaluation of Patients with Serial Echocardiographic Findings
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Overall (n = 301) | 13–15 y (n = 207) | 16–18 y (n = 94) | p-Value |
---|---|---|---|---|
Age, y | 15 ± 1.6 | 14 ± 0.8 | 17 ± 0.7 | - |
BMI (kg/m2) | 21 ± 5.0 | 20 ± 4.8 | 22 ± 5.2 | 0.017 |
Male sex, n (%) | 202 (67.1) | 110 (53.1) | 92 (97.9) | <0.0001 * |
Underlying disease n (%) | 44 (14.6) | 31 (15.0) | 13 (13.8) | 0.795 |
Allergic rhinitis | 24 (8.0) | 17 (8.2) | 7 (7.4) | 0.813 |
Asthma | 7 (2.3) | 5 (2.4) | 2 (2.1) | 0.869 |
Thalassemia trait | 5 (1.7) | 3 (1.4) | 2 (2.1) | 0.688 |
G6PD deficiency | 4 (1.3) | 3 (1.4) | 1 (1.1) | 0.782 |
Attention deficit | 1 (0.3) | 1 (0.5) | 0 | 0.500 |
Epilepsy | 1 (0.3) | 1 (0.5) | 0 | 0.500 |
Migraine | 1 (0.3) | 1 (0.5) | 0 | 0.500 |
Thyrotoxicosis | 1 (0.3) | 0 | 1 (1.1) | 0.500 |
Symptoms, n (%) | ||||
Fever | 50 (16.6) | 30 (14.5) | 20 (21.3) | 0.093 |
Palpitation | 12 (4.0) | 10 (4.8) | 2 (2.1) | 0.268 |
Chest pain | 8 (2.7) | 5 (2.4) | 3 (3.2) | 0.699 |
Shortness of breath | 19 (6.3) | 16 (7.7) | 3 (3.2) | 0.134 |
Headache | 35 (11.6) | 27 (13.0) | 8 (8.5) | 0.257 |
Laboratory findings | ||||
Troponin-T, ng/L | 5.6 ± 2.5 | 5.4 ± 2.5 | 5.9 ± 2.5 | 0.112 |
CK-MB ng/mL | 1.4 ± 0.9 | 1.4 ± 0.9 | 1.5 ± 0.9 | 0.473 |
Treatment and hospital course | ||||
NSAIDS, n (%) | 3 (1.0) | 1 (0.5) | 2 (2.1) | 0.178 |
Hospitalization, n (%) | 2 (0.7) | 0 | 2 (2.1) | 0.035 |
ICU admission, n (%) | 1 (0.3) | 0 | 1 (1.1) | 0.138 |
Variable | Value |
---|---|
Presenting symptoms and signs—Number/total number (%) Chest pain Chest discomfort Pericardial effusion Fever Headache Palpitation Dyspnea | 3/7 (42.86) 3/7 (42.86) 3/7 (42.86) 4/7 (57.14) 2/7 (28.57) 1/7 (14.29) 1/7 (14.29) |
Vital signs on day of symptoms (Mean ± SD) | |
Temperature—°C Blood pressure—mmHg Systolic Diastolic Heart rate—beats/min | 36.4 ± 0.4 114.9 ± 10.9 70.7 ± 7.8 92.71 ± 21.3 |
Shock-Number/total number. (%) | 0/7 (0) |
Electrocardiographic findings—Number/total number (%) Normal sinus rhythm Sinus rhythm with sinus arrhythmia Diffuse ST elevation with PR depression Sinus arrhythmia with PAC Sinus tachycardia Junctional escape rhythm | 1/7 (14.29) 2/7 (28.57) 1/7 (14.29) 1/7 (14.29) 1/7 (14.29) 1/7 (14.29) |
Laboratory values Elevated troponin-T | 5/7 (71.43) |
Clinical course Arrhythmia ICU admission Need for inotrope or vasopressor Death | 4/7 (57.14) 1/7 (14.29) 0/7 (0) 0/7 (0) |
Treatment and hospital course Ibuprofen (NSAIDs) | 3/7 (42.86) |
Demographic | Clinical Presentation | Echocardiography | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. | Age (y) | Sex | Classification | Peak CRP (mg/ L) | Peak ESR (mm/hr) | CK-MB Level (ng/mL) | Troponin-T (pg/mL) | LVEF% | Pericardial Effusion | |||||||||
1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 | |||||||
1 | 16 | Male | Myopericarditis | 86.6 | 19 | 1.25 | 109.6 | 2.36 | 1.67 | 3.18 | 593 | 37.2 | 10.9 | 75.3 | 73.7 | 77.2 | 84.7 | Yes |
2 | 15 | Male | Pericarditis | 1.3 | 7 | 1.11 | 1.34 | 1.52 | 1.46 | 2.58 | 3.77 | 6.04 | 3.93 | 61.5 | 60.2 | 74.1 | 70.7 | Yes |
3 | 17 | Male | Pericarditis | 10.5 | 8 | 1.99 | 1.87 | 1.72 | 2.71 | 4.54 | 8.03 | 7.87 | 6.75 | 78.9 | 77.5 | 61.0 | 67.2 | Yes |
4 | 13 | Male | Subclinical myocarditis | 0.3 | - | 1.39 | 1.72 | 2.28 | - | 8.56 | 10.3 | 34.94 | - | 58.6 | 59.2 | 75.4 | - | No |
5 | 14 | Male | Subclinical myocarditis | 0.5 | - | 3.00 | 2.06 | 3.06 | - | 3.73 | 28.6 | 38.68 | - | 79.6 | 60.1 | 76.2 | - | No |
6 | 13 | Male | Subclinical myocarditis | 0.9 | - | 3.90 | 3.67 | 5.10 | - | 5.35 | 14.87 | 16.81 | - | 64.3 | 76.2 | 78.9 | - | No |
7 | 17 | Male | Subclinical myocarditis | 4.3 | - | 2.25 | 2.32 | 2.41 | - | 3.12 | 13.06 | 15.44 | - | 70.8 | 52.4 | 53.8 | - | No |
Rhythm | Number (n = 301) |
---|---|
Normal sinus rhythm | 247 (82.06%) |
Sinus rhythm with sinus arrhythmia | 22 (7.31%) |
Sinus tachycardia | 20 (6.64%) |
Sinus bradycardia | 4 (1.33%) |
Premature atrial contraction (PAC) | 3 (1%) |
Premature ventricular contraction (PVC) | 2 (0.66%) |
Junctional escape rhythm | 1 (0.33%) |
Ectopic atrial rhythm | 1 (0.33%) |
Diffuse ST elevation with PR depression | 1 (0.33%) |
Cardiac Function | Day0 | Day3 | Day7 | p-Value D0 vs. D3 | p-Value D0 vs. D7 | p-Value D3 vs. D7 |
---|---|---|---|---|---|---|
IVSD, mean ± SD | 1.18 ± 4.83 | 0.99 ± 1.51 | 0.93 ± 1.32 | 0.508 | 0.383 | 0.596 |
LVIDd, mean ± SD | 4.43 ± 3.22 | 4.34 ± 3.02 | 4.81 ± 5.02 | 0.735 | 0.209 | 0.168 |
LVPWd, mean ± SD | 0.96 ± 0.67 | 0.91 ± 0.81 | 1.28 ± 5.16 | 0.431 | 0.299 | 0.234 |
LVIDs, mean ± SD | 2.64 ± 1.65 | 2.85 ± 2.82 | 2.60 ± 0.5 | 0.250 | 0.730 | 0.128 |
LVEF, mean ± SD | 68.68 ± 9.27 | 68.21 ± 9.18 | 68.30 ± 8.56 | 0.490 | 0.585 | 0.878 |
MV flow E-wave velocity mean ± SD | 99.32 ± 18.77 | 98.98 ± 20.47 | 99.93 ± 21.05 | 0.791 | 0.773 | 0.391 |
MV flow A-wave velocity mean ± SD | 53.37 ± 16.10 | 52.39 ± 15.39 | 51.23 ± 16.18 | 0.432 | 0.046 | 0.217 |
MV annulus E-wave velocity, mean ± SD | 2.11 ± 1.28 | 2.03 ± 0.63 | 2.06 ± 1.18 | 0.281 | 0.632 | 0.653 |
e’, mean ± SD | 0.12 ± 0.05 | 0.13 ± 0.10 | 0.18 ± 0.55 | 0.227 | 0.097 | 0.065 |
E/e´, mean ± SD | 8.33 ± 2.63 | 8.22 ± 2.03 | 9.29 ± 8.27 | 0.551 | 0.277 | 0.125 |
a´, mean ± SD | 0.08 ± 0.06 | 0.08 ± 0.04 | 0.16 ± 0.79 | 0.393 | 0.201 | 0.091 |
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Mansanguan, S.; Charunwatthana, P.; Piyaphanee, W.; Dechkhajorn, W.; Poolcharoen, A.; Mansanguan, C. Cardiovascular Manifestation of the BNT162b2 mRNA COVID-19 Vaccine in Adolescents. Trop. Med. Infect. Dis. 2022, 7, 196. https://doi.org/10.3390/tropicalmed7080196
Mansanguan S, Charunwatthana P, Piyaphanee W, Dechkhajorn W, Poolcharoen A, Mansanguan C. Cardiovascular Manifestation of the BNT162b2 mRNA COVID-19 Vaccine in Adolescents. Tropical Medicine and Infectious Disease. 2022; 7(8):196. https://doi.org/10.3390/tropicalmed7080196
Chicago/Turabian StyleMansanguan, Suyanee, Prakaykaew Charunwatthana, Watcharapong Piyaphanee, Wilanee Dechkhajorn, Akkapon Poolcharoen, and Chayasin Mansanguan. 2022. "Cardiovascular Manifestation of the BNT162b2 mRNA COVID-19 Vaccine in Adolescents" Tropical Medicine and Infectious Disease 7, no. 8: 196. https://doi.org/10.3390/tropicalmed7080196