Levels of high-sensitive troponin T and mid-regional pro-adrenomedullin after COVID-19 vaccination in vulnerable groups: monitoring cardiovascular safety of COVID-19 vaccination

Samipa Pudasaini; Ngoc Han Le; Dörte Huscher; Fabian Holert; David Hillus; Pinkus Tober-Lau; Florian Kurth; Leif Erik Sander; Martin Möckel

doi:10.3389/fcvm.2024.1435038

Levels of high-sensitive troponin T and mid-regional pro-adrenomedullin after COVID-19 vaccination in vulnerable groups: monitoring cardiovascular safety of COVID-19 vaccination

Front Cardiovasc Med. 2024 Oct 18:11:1435038. doi: 10.3389/fcvm.2024.1435038. eCollection 2024.

Authors

Affiliations

¹ Department of Emergency and Acute Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany.
² Department of Infectious Diseases and Pulmonary Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany.
³ Institute of Biometry and Clinical Epidemiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany.
⁴ Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Background: COVID-19 vaccines are well tolerated and effective but may have adverse effects 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.

Methods: This 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; V_{2, 3}: 3-4 weeks after 1st and 2nd vaccination). HsTnT of HCWs was compared to a healthy reference population.

Results: N = 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 4 ng/L, 5 ng/L and 4 ng/L (V₁-V₃) for AZ/BNT and at 5 ng/L, 6 ng/L and 6 ng/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. Median MR-proADM values were 0.43 nmol/L, 0.45 nmol/L, 0.44 nmol/L (V₁-V₃) in the AZ/BNT cohort and 0.49 nmol/L, 0.44 nmol/L, 0.47 nmol/L for BNT/BNT, respectively. Change of median hsTnT and MR-proADM between visits did not show significant increases. One HCW experienced a permanent and three a transient hsTnT increase ≥14 ng/L.

Conclusion: No overall subtle, persistent cardiovascular involvement was observed after the 2nd COVID-19 vaccination. Elevated cardiovascular biomarkers in clinically asymptomatic individuals need further investigations.

Keywords: COVID-19 vaccination; endothelial dysfunction; high-sensitive troponin T; mid-regional pro-adrenomedullin; persistent myocardial injury.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was funded by “Forschungsnetzwerk der Universitätsmedizin zu COVID-19”, the Federal Ministry of Education and Research (BMBF), Zalando SE, the Federal Institute for Drugs and Medical Devices and intramural funds of Charité - Universitätsmedizin Berlin. The BIC-1 study was performed in collaboration with the Heidelberg university hospital. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.