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Preliminary results from two UK studies suggest significant heart inflammation from COVID

Early results from some large-scale national studies suggest that up to one in eight UK hospitalised patients subsequently shows signs of heart injury, writes The Telegraph. It cites two ongoing studies at the universities of Glasgow and Oxford.

The Telegraph writes:

COVID has been considered primarily as a lung infection, reports But early results from large-scale national studies now suggest that up to one in eight hospitalised patients subsequently shows signs of heart injury from the illness.

Colin Berry, professor of cardiology and imaging at the University of Glasgow, is leading one such study. His team has assessed a random sample of 161 recovering COVID patients, 90% of whom had been hospitalised, and one in five of whom had needed high-level or intensive-care treatment. At between one and two months after discharge, their hearts, lungs and kidneys were medically scanned.

The results are yet to be published in a peer-reviewed scientific journal, but Berry says: “About one patient in eight had evidence of heart inflammation. That is a high incidence.”

Research is showing that COVID-linked inflammation of the heart muscle (myocarditis) can reduce the heartʼs ability to pump and can cause arrhythmias – rapid or irregular heart rhythms – as well as dizziness, chest pain and shortness of breath. It may cause scarring of the heart muscle that can affect its ability to pump properly. Study evidence also suggests that COVID infection can injure heart valves. In Berryʼs study the cardiac damage does not end there.

“The heart inflammation fits with a bigger picture of illness,” he said. “We found that quality of life, physical and mental health, was lower in patients with heart inflammation. We also saw damage to kidney function in patients who had inflamed hearts.”

Similar results are being uncovered by Dr Betty Raman, a British Heart Foundation clinical research fellow at the University of Oxford, who is using magnetic resonance imaging to study the hearts, brains, livers and kidneys of 500 people taking part in the Post-hospitalisation COVID-19 study (Phosp-Covid), involving 10,000 UK patients.

She said a preliminary assessment of 58 patients showed inflammation of multiple organs, the heart and vascular system in particular. The worse a personʼs initial COVID symptoms, the worse the subsequent damage, she said.

Worryingly, post-COVID inflammation can damage hearts and blood vessel tissues so seriously that they may create clots that can cause strokes and damage other vital organs.

“Some people may have inflammation damage. Other patients have the vascular damage, and some may have both,” Raman says. “This might explain the differences in how the virus affects people in long COVID. The wide range of differing symptoms suggests that there are multiple mechanisms.”

The Office for National Statistics estimates there are around 1,2m people in the UK with long COVID – post-coronavirus symptoms that may frequently include heart disturbances. Already hospital waiting lists for vital heart care are at record levels, the British Heart Foundation warned last month. More than 275,000 people are waiting for heart tests and treatment in England alone.

Further evidence of a looming cardiac crisis comes from Danish research, which shows that other post-COVID patients can also suffer physical heart damage to their heart valves – the ventricles – from inflammation during the acute phase of COVID infection.

In September, a study in the European Journal of Heart Failure by cardiologists at the University of Copenhagen reported that while the right ventricle appears to heal after infection, damage to the left ventricle may be permanent. Heart failure generally begins with left-ventricle problems, as this is the heartʼs main pumping chamber

And in the Journal of the American Medical Association last month, a study of 4,000 patients who suffered heart attacks while hospitalised with COVID were warned that their risk of death was 79 %, compared with 46% for people who had the same type of heart attack but were not infected with COVID.

Fears about COVID vaccines were stoked last month by a research abstract, published in the American Heart Association journal Circulation, which said that mRNA vaccines, such as the Pfizer-BioNTech jab, can cause heart-cell inflammation. Numerous clinical experts criticised the abstract, which does not detail a full study and has not been peer-reviewed.

The American Heart Association subsequently published an “expression of concern” in Circulation to warn that the passage may not be reliable and that a “suitable correction” was needed.

Meanwhile, two large studies published in the highly regarded New England Journal of Medicine in October have shown that the risk of myocarditis inflammation of the heart muscle after receiving the Pfizer vaccine is very low, even among teenage boys and young men – the groups most at risk of developing the condition.

One of the studies, from Israel, rates the chance of developing the condition at about one in 50,000, adding that most cases are mild and people recover quickly, reports The Telegraph.

David Strain, a clinical senior lecturer at Exeter University who is conducting studies of long COVID, says: “Any myocarditis from the vaccine probably involves the same process that occurs when COVID causes heart inflammation. Itʼs likely the same people are at risk in both cases. The symptoms they get after the vaccine would be minor, but they would be really bad if they are unvaccinated and get COVID.”

Study details

Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

Dror Mevorach, Emilia Anis, Noa Cedar, Michal Bromberg , Eric J Haas, Eyal Nadir, Sharon Olsha-Castell, Dana Arad, Tal Hasin, Nir Levi, Rabea Asleh , Offer Amir, Karen Meir, Dotan Cohen, Rita Dichtiar , Deborah Novick, Yael Hershkovitz, Ron Dagan, Iris Leitersdorf , Ronen Ben-Ami, Ian Miskin , Walid Saliba, Khitam Muhsen, Yehezkel Levi, Manfred S Green, Lital Keinan-Boker , Sharon Alroy-Preis

Published in New England Journal of Medicine on 6 October 2021

Abstract

Background
Approximately 5.1 million Israelis had been fully immunised against coronavirus disease 2019 (COVID-19) after receiving two doses of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) by May 31, 2021. After early reports of myocarditis during adverse events monitoring, the Israeli Ministry of Health initiated active surveillance.

Methods
We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorised the information using the Brighton Collaboration definition. We analysed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart); by calculating the standardised incidence ratio of the observed-to-expected incidence within 21 days after the first dose and 30 days after the second dose, independent of certainty of diagnosis; and by calculating the rate ratio 30 days after the second dose as compared with unvaccinated persons.

Results
Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardised incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637.

Conclusions
The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.

 

The Telegraph article – How Covid might affect your heart (Restricted access)

 

New England Journal of Medicine article – Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel (Open access)

 

See more from MedicalBrief archives:

 

Pfizer vaccination linked to 3x high risk of myocarditis — Israel study

 

mRNA vaccines may pose acute coronary syndrome risk — US study

 

Healthy boys at greater risk from vaccination than COVID itself — US analysis

 

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