"Abstract
Cardiac discomfort has been reported periodically in COVID‑19‑vaccinated individuals. Thus, this study aimed to evaluate the role of myocardial strains in the early assessment of the clinical presentations after COVID‑19 vaccination...
Introduction
... [S]everal adverse events (AEs) have been reported after COVID-19 vaccine administration. Myocarditis, which is inflammation of the myocardium, has been noted as a sporadic side effect of the vaccine... Among 81 patients with cancer who received immune checkpoint inhibitors (ICIs), 6 developed clinical presentations suspicious for irAEs, including myositis and cardiogenic shock, after administration of a COVID-19 mRNA vaccine...
In our clinical practice, we found that several patients who received a COVID-19 vaccine developed cardiac-related discomfort that did not meet the diagnostic criteria of myocarditis. Angeli et al. described the occurrence of an adverse reaction, hypertension after COVID-19 vaccination. According to the mechanism of the mRNA vaccine, free-floating S protein might expand a massive interaction with the ACE2 receptors leading to receptor degradation, which would subsequently contribute to hypertension. Hence, a relationship between cardiac discomfort and COVID-19 vaccination is probable...
Results
Patient characteristics and cardiac biomarkers
In total, 121 patients who met the inclusion criteria and for whom adequate image quality for tissue tracking analysis was obtained were recruited for this study. Patients who were vaccinated and developed cardiac-related discomfort according to verbal inquiry and medical history questionnaire and clinical interview (n = 66; mean age, 55.4 ± 17.4 years) were classified as a symptomatic group and those who were recruited from health check center and vaccinated without developing adverse cardiac outcomes (n = 55; mean age, 53.7 ± 14.8 years) were classified as a control group...
Discussion
Our study was conducted in Taiwan since the early period of the COVID-19 pandemic. There were only a small number of COVID-19 infected patients here. None of our study population had the previous infection. Our study results showed that global myocardial strain, including longitudinal strain and circumferential strain, are sensitive, non-invasive, and reproducible indices that are clinically relevant to the subtle changes in the left ventricular myocardium that may occur as a consequence of the cardiac impact of COVID-19 vaccination. Hence, we found that the potential capability of tissue speckle tracking analysis can evaluate and indicate early myocardial dysfunction and adverse cardiac events after immunization with COVID-19 vaccines...
To comprehensively identify the cardiac adverse effects of vaccination, it is necessary to consider an ideal control group of individuals who have never received the COVID-19 vaccine."
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