Sub-acute Effects of Vaccination With a Messenger RNA-based Vaccine against Coronavirus Disease 2019 on Elderly Japanese Patients with Cardiac Disorder

Abstract

Ryuichi Tamimoto41138, Toshiharu Fujii41139, Hirofumi Nagamatsu41140, Tsutomu Murakami41141, Koji Miyazaki41142, Shinya Goto41143, Yasunori Cho41144 and Hidezo Mori41145*

Background: The incidence of acute myocarditis as a sub-acute side effect after vaccination with an mRNA- based vaccine against Coronavirus Disease 2019 (COVID-19) in elderly patients with cardiac dysfunction is unknown. This study assessed adverse cardiac events following vaccination.

Methods: This observational study evaluated all- cause mortality and deterioration of heart failure in 100 Japanese patients who underwent vaccination with an mRNA-based vaccine against COVID-19. Heart failure status was assessed using the Brain Natriuretic Peptide (BNP) ratio, for which the BNP or N Terminal (NT)-pro BNP values were divided by their Upper Normal Limits (UNL). Deterioration was assessed based on changes in the BNP ratio; values (i.e., post-BNP levels minus pre-BNP levels) ≥ 10-fold higher than the UNL denoted significant increment.

Results: The BNP ratio increased from 4.5 (Interquartile range: 1.5-13.6) to 5.9 (Interquartile range: 1.8-19.5) after vaccination (P<0.01). After the first vaccination (Follow-up: 20-222 days), six patients expired and 15 patients exhibited significant increment of the BNP ratio; these patients had a pre-BNP ratio ≥ 4-fold higher than the UNL. Forty-five patients with pre-BNP ratio <4-fold higher than the UNL did not expire or show significant increase in the BNP ratio. The pre-BNP ratio was reliable in predicting cardiac deterioration (Crude Hazard Ratio: 1.02; 95% Confidence Interval (CI): 1.01-1.03; P<0.01).

Conclusion: A BNP ratio ≥ 4-fold higher than the UNL was associated with a high risk of death in elderly patients after vaccination against COVID-19. The BNP ratio may be useful for assessing the cardiac status of elderly patients in this setting.