Levels of high-sensitive troponin T and mid-regional pro-adrenomedullin after COVID-19 vaccination in vulnerable groups: a prospective study on subtle and persistent cardiovascular involvement

BackgroundThis study examines potential, subtle and persistent adverse effects of COVID-19 vaccines on the cardiovascular system. Vaccine-associated myocardial injury was analysed by measuring high-sensitive troponin T (hsTnT); mid-regional pro-adrenomedullin (MR-proADM) levels were evaluated to assess endothelial dysfunction. MethodsThis was a prospective study with a vulnerable population of healthcare workers (HCWs) and elderly patients (> 70 years) who were vaccinated with either one dose of ChAdOx1 nCov-19 adenoviral vector vaccine (AZ) followed by one dose of the BNT162b2 messenger RNA vaccine (BNT), or with two doses of BNT (12th of January - 30th of November 2021). HsTnT and MR-proADM were measured in blood samples at three visits (V1: 1st immediately before vaccination; V2, 3: 3-4 weeks after 1st and 2nd vaccination). HsTnT of HCWs was compared to a healthy reference population. ResultsN=162 volunteers were included (V1=161; V2, V3=162 each). N=74 (45.7%) received AZ/BNT and n=88 (54.3%) received BNT/BNT (elderly: n=20 (12.3%), HCWs: n=68 (42.0%)). Median hsTnT levels were 4ng/L, 5ng/L and 4ng/L (V1-V3) for AZ/BNT and at 5ng/L, 6ng/L and 6ng/L (V1-V3) for BNT/BNT. Compared to the reference population (n=300), hsTnT was significantly higher at all visits for both vaccination groups (p<0.01), without differences between the AZ/BNT and BNT/BNT cohort. MR-proADM values were 0.43nmol/L, 0.45nmol/L, 0.44nmol/L (V1-V3) in the AZ/BNT cohort and 0.49nmol/L, 0.44nmol/L, 0.47nmol/L for BNT/BNT, respectively. Change of median hsTnT and MR-proADM between visits did not show significant increases. One HCW case had a permanent and three a transient hsTnT increase [&ge;]14ng/L. ConclusionWith one individual exception, no overall subtle, persistent cardiovascular involvement was observed after the 2nd COVID-19 vaccination. Structured graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=124 SRC="FIGDIR/small/24307207v1_ufig1.gif" ALT="Figure 1"> View larger version (25K): org.highwire.dtl.DTLVardef@15eb8f2org.highwire.dtl.DTLVardef@1c03237org.highwire.dtl.DTLVardef@120c0f5org.highwire.dtl.DTLVardef@15c1ea2_HPS_FORMAT_FIGEXP M_FIG Summary of the vaccination scheme and visiting points in the study population (of HCWs and seniors > 70 years) between the 12th of January and the 30th of November 2021. The results showed no overall subtle, chronic myocardial or vascular involvement in our COVID-19 vaccinated cohorts. Abbreviations: AZ ChAdOx1 nCov-19 adenoviral vector vaccine from Astra Zeneca, BNT BNT162b2 messenger ribonucleic acid vaccine from BioNTech, EDTA Ethylenediaminetetraacetic acid, HCWs health care workers, hsTnT high-sensitive troponin T, mid-regional pro-adrenomedullin, V1-V3 visiting times 1-3, w week(s). C_FIG