PERICARDITIS AFTER COVID-19 VACCINATION: A CASE SERIES

BackgroundCOVID-19 vaccination campaigns successfully impacted on viral spreading and in particular on clinical course of the disease. However, secondary to a highly extended vaccination program, several local and systemic adverse events associated with mRNA COVID-19 vaccines have been reported. Pericarditis and myocarditis are examples of cardiac complications related to these vaccines. In particular, cases of pericarditis have occurred after mRNA COVID-19 vaccination (mostly secondary to vaccination with Moderna than Pfizer-BioNTech), especially in male adolescents and young adults, more often after the second dose. The incidence is approximately of 1-2 cases/100.000.ObjectivesAim of our study was to study the clinical profile of pericarditis occurred within 30 days after COVID-19 vaccines in our clinic.MethodsWe present a case series of patients who developed pericarditis after COVID-19 vaccination in the Department of Internal Medicine at Fatebenefratelli Hospital in Milan, followed from December 1, 2021 to April 15, 2022.ResultsTwenty-five individuals, of which 18 (72%) were women and 7 (28%) were males, had vaccine related pericarditis. Two patients were vaccinated with AstraZeneca, 2 with Moderna, the remaining with Pfizer-BioNTech. Median age was of 42 years. Of all patients, one subject was affected by constrictive effusive pericarditis, while another required treatment of pericarditis with Anakinra, switched to Canakinumab after severe skin reactions, because of failure of therapeutic response to first-line treatments.Two patients required hospital admission, in one case for a transient constrictive pericarditis. In the remaining cases clinical symptoms associated with post-vaccines pericarditis were mild and didn't require hospitalization.Chest pain was reported in 100% of cases, whereas pericardial effusion (in one case larger than 10 mm) was evidenced in 30% of subjects. Eighty percent of patients experienced tachycardia, whereas 90% reported asthenia.An increase in indices of inflammation (CRP) was documented in 50% of patients, usually mild.With regard to therapy, 90% of patients were treated with NSAIDs, 95% with colchicine, while 50% of cases required treatment with low-dose steroids.ConclusionCOVID-19 vaccination induces a particular form of pericarditis, often insidious and very troublesome, but with good prognosis. The clinical phenotype showed less typical chest pain, often normal indices of inflammation and little or no instrumental changes, but patients often experimented tachycardia and functional limitation. With regard to therapy, we used NSAIDs at adequate dosages to control the clinical condition, or low-dose colchicine. Low doses of cortisone (e.g., prednisone 5-10 mg a day) were useful in the presence of marked asthenia or systemic symptoms. Beta-blockers or ivabradine were used in the presence of tachycardia.References[1]Barda N, Children 2021, 8(7), 607;Safety of the BNT162b2 mRNA Covid-19 in a Nationwide setting. N Engl J med 2021;385:1078-1090.[2]Diaz GA, Myocarditis and Pericarditis After Vaccination for COVID-19. JAMA 2021;326 (12): 1210-1212.[3]Bibhuti D, Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination: What Do We Know So Far?. Children 2021, 8(7), 607.[4]Giacomo Maria Viani, Patrizia Pedrotti, Romano Seregni, and Brucato Antonio;Effusive–constrictive pericarditis after the second dose of BNT162b2 vaccine (Comirnaty): a case report;European Heart Journal - Case Reports (2022) 6(2), 1–6.[5]Francesco Perna, Elena Verecchia, Gaetano Pinnacchio, Laura Gerardino, Antonio Brucato, and Raffaele Manna;Rapid resolution of severe pericardial effusion using anakinra in a patient with COVID-19 vaccine-related acute pericarditis relapse:a case report;European Heart Journal - Case Reports (2022) 6, 1–6.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Gender differences in patients hospitalized for COVID-19 disease

Background and Aim: The aim of this study is to evaluate gender differences in patients hospitalized for COVID-19 in terms of symptoms, laboratory data and disease outcomes, and to identify variables capable of increasing the risk of critical illness and lethality. Methods: Prospective observational study in the COVID wards of the ASST Fatebenefratelli-Sacco (MI), during the first wave of the pandemic. All COVID patients were included. A descriptive analysis was carried out to assess the relationship between several variables and gender, and a multivariate analysis to establish the association of the variables analyzed with disease severity and in-hospital mortality. The probability of survival at 30 days was evaluated by Kaplan-Meier curves. Results: 520 patients, 67% male and 33% female, were recruited. Of males, 30.1% presented with critical conditions at hospitalization, 18.7% in females. Mortality was 24.6% among males and 15.8% in females. Criticality at onset was associated with: high CRP, elevated LDH, increase of days from onset of symptoms. Mortality during hospitalization was associated with: age, obesity, critical conditions at admission, some laboratory analytes (decreased haemoglobin, elevated D-dimer, elevated LDH, reduced eGFR, elevated CK). The 30-day survival probability was 88% for women and 77% for men. Conclusions: Females are more protected against SARS-CoV-2 infection, have a better clinical and laboratory profile and subject to less lethality. Males are more hospitalized and more at risk of developing severe and lethal forms of the disease.

Evaluation of the incidence of post SARS-CoV2 vaccine pericarditis in patients with a previous diagnosis of pericarditis

Background and Aim: Incidence of pericarditis (PC) after SARSCoV2 vaccination is about 2 events for 100.000 vaccinated. Incidence of recurrence of PC after vaccination is still not ascertained in the population previously diagnosed with PC. Methods: We administered a questionnaire recording data about eventual recurrences and inclination towards further vaccination in a population of pts with a previous diagnosis of PC. Results: 136 pts completed the questionnaire. 120 (88,2%) were vaccinated. Among vaccinated pts, 10 cases (8.3%, 7 F, 3M, average age 39.8 y) had a recurrence of pericarditis;1 case 32 days after the second dose, 9 within 25 days from vaccination (mainly after the second dose). 4 after Astra Zeneca and 6 after mRNA vaccine. 7/10 pts were treated as outpatients, while 3/10 required hospital admission. Of all recurrences, 60% were on maintenance therapy for PC, while 40% were not in therapy. Among 120 vaccinated patients, 90,8% reported they were favorable to complete vaccination cycle, 1,7% patients stated they would not complete vaccination and 7,5% were not sure. Among 10 patients with a recurrence after vaccination, only 1 declared that he wouldn't do it again. Conclusions: In a cohort of 120 patients with a diagnosis of PC undergoing vaccination for SARS-CoV2, 8,3% reported an exacerbation of signs or symptoms of PC;however, 90% of them reported they would do the vaccine dose again.

Novel Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020

Recent advances have shown impressive results by anti-interleukin 1 (IL-1) agents in refractory idiopathic recurrent pericarditis. PURPOSE OF REVIEW: We critically discuss the current state of the art of therapy of relapsing pericarditis, with a focus on new pharmacological approaches and on specific clinical settings such as pregnancy, pediatric patients, and secondary forms of relapsing pericarditis. RECENT FINDINGS: Antagonism of the IL-1 is highly effective in idiopathic recurrent pericarditis with autoinflammatory features. Currently, available anti-IL-1 agents are anakinra and canakinumab. Rilonacept is another IL-1 antagonist, currently studied in the phase-3 clinical trial RHAPSODY. Available data suggest similar efficacy and safety profiles of these three agents, although only anakinra has been tested in randomized clinical trials. These agents have slightly different pharmacological properties, being canakinumab a specific IL-1ss antagonist while anakinra and rilonacept are unselective IL-1alpha and IL-1ss blockers. To date, there is no evidence that specificity against IL-1ss affects safety and efficacy in patients with relapsing pericarditis, although it has been proposed that unspecific blockage might be useful in severe disease. Anakinra is the first anti-IL-1 agent with well-documented efficacy and safety in adult and pediatric patients with idiopathic relapsing pericarditis. Other anti-IL-1 agents are currently under study. Future research should clarify the optimal duration of therapy and tapering schedule of treatment with these agents. Moreover, biomarkers would be required to understand which patients will benefit from early administration of IL-1 blockers due to refractoriness to conventional therapy and which others will suffer from recurrences during the tapering of these agents. Lastly, future studies should focus on the subjects with the autoimmune or the pauci-inflammatory phenotype of idiopathic refractory pericarditis.