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Sex-specific differences in myocardial injury incidence after COVID-19 mRNA-1273 booster vaccination |
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| Authors: | Natacha Buergin Pedro Lopez-Ayala Julia R. Hirsiger Philip Mueller Daniela Median Noemi Glarner Klara Rumora Timon Herrmann Luca Koechlin Philip Haaf Katharina Rentsch Manuel Battegay Florian Banderet Christoph T. Berger Christian Mueller |
| Affiliation: | 1. Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland;2. Department of Biomedicine, Translational Immunology, University of Basel, Basel, Switzerland;3. Department of Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland;4. Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland;5. Department of Internal Medicine, Medical Outpatient Unit, University Hospital Basel, Basel, Switzerland Health Service, University Hospital Basel, Basel, Switzerland;6. Department of Biomedicine, Translational Immunology, University of Basel, Basel, Switzerland University Center for Immunology, University Hospital Basel, Basel, Switzerland |
| Abstract: | AimsTo explore the incidence and potential mechanisms of oligosymptomatic myocardial injury following COVID-19 mRNA booster vaccination.Methods and resultsHospital employees scheduled to undergo mRNA-1273 booster vaccination were assessed for mRNA-1273 vaccination-associated myocardial injury, defined as acute dynamic increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration above the sex-specific upper limit of normal on day 3 (48–96 h) after vaccination without evidence of an alternative cause. To explore possible mechanisms, antibodies against interleukin-1 receptor antagonist (IL-1RA), the SARS-CoV-2-nucleoprotein (NP) and -spike (S1) proteins and an array of 14 inflammatory cytokines were quantified. Among 777 participants (median age 37 years, 69.5% women), 40 participants (5.1%; 95% confidence interval [CI] 3.7–7.0%) had elevated hs-cTnT concentration on day 3 and mRNA-1273 vaccine-associated myocardial injury was adjudicated in 22 participants (2.8% [95% CI 1.7–4.3%]). Twenty cases occurred in women (3.7% [95% CI 2.3–5.7%]), two in men (0.8% [95% CI 0.1–3.0%]). Hs-cTnT elevations were mild and only temporary. No patient had electrocardiographic changes, and none developed major adverse cardiac events within 30 days (0% [95% CI 0–0.4%]). In the overall booster cohort, hs-cTnT concentrations (day 3; median 5, interquartile range [IQR] 4–6 ng/L) were significantly higher compared to matched controls (n = 777, median 3 [IQR 3–5] ng/L, p < 0.001). Cases had comparable systemic reactogenicity, concentrations of anti-IL-1RA, anti-NP, anti-S1, and markers quantifying systemic inflammation, but lower concentrations of interferon (IFN)-λ1 (IL-29) and granulocyte-macrophage colony-stimulating factor (GM-CSF) versus persons without vaccine-associated myocardial injury.ConclusionmRNA-1273 vaccine-associated myocardial injury was more common than previously thought, being mild and transient, and more frequent in women versus men. The possible protective role of IFN-λ1 (IL-29) and GM-CSF warrant further studies. |
| Keywords: | COVID-19 mRNA vaccine Myocardial injury Myocarditis COVID-19 booster vaccination Cardiac troponin |