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

Background This 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. 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 (12 th of January - 30 th of November 2021). HsTnT and MR-proADM were measured in blood samples at three visits (V 1 : 1 st immediately before vaccination; V 2, 3 : 3-4 weeks after 1 st and 2 nd vaccination). HsTnT of HCWs was compared to a healthy reference population. Results N=162 volunteers were included (V 1 =161; V 2 , V 3 =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 (V 1 -V 3 ) for AZ/BNT and at 5ng/L, 6ng/L and 6ng/L (V 1 -V 3 ) 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 (V 1 -V 3 ) 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 ≥14ng/L. Conclusion With one individual exception, no overall subtle, persistent cardiovascular involvement was observed after the 2 nd COVID-19 vaccination. Structured graphical abstract Summary of the vaccination scheme and visiting points in the study population (of HCWs and seniors > 70 years) between the 12 th of January and the 30 th 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, V 1 -V 3 visiting times 1-3, w week(s).