Evaluation of some cardiac markers in relation to COVID-19 mRNA vaccine

Background: Acute myocardial infarction (AMI) is a dangerous cardiovascular illness that has a significant impact on people's health. Several biomarkers, including Myoglobin and troponin I (cTnI) were utilized to diagnose AMI in recent decades. The Troponin I (cTnI) was designated as the "gold standard" cardiac biomarker for the prediction of cardiomyopathy. It's a heart muscle regulating protein found on normal myocyte actin filaments. When cardiac muscles are injured, cTnI, one of the main subunits of the cardiac troponin complex, is released into the circulation (e.g., myocardial infarction). Myoglobin denoted by (symbols Mb and MB) seems to be an iron- and o2-binding protein present in the vertebrate heart and skeletal muscle tissues and, more specifically, nearly all mammals. In humans, MB is only present in the bloodstream following muscle damage. Its primary function is to supply myocytes with oxygen. Also essential to nitric oxide hemostasis was myoglobin. Additionally, it facilitates the detoxification of response oxygen molecules from the body. MB is accountable for most vertebrate muscles' red hue.The aim: To assess the difference in the level of (MYOGLOBIN and TROPONIN_I) between patients with and without mRNA Vaccination.
Methods: This study included 125 patients (65 male and 60 female) with vaccinated and non-vaccinated covid-19 with an age range of 20–69 years. These patients are divided into two main groups: 1. vaccinated (vaccinated with COVID-19 infection, vaccinated without COVID-19 disease, vaccinated recovered from the CoV-19 virus),2. unvaccinated (infected with the CoV-19 virus and non-vaccinated, recovered from covid-19 and unvaccinated). The outcome is measured using the Enzyme-linked immunosorbent assay (ELISA) technique. This study was conducted during the period from November 2021 to May 2022 at the Martyr Dr. Fairouz General Hospital, Wasit governorate, Iraq.
Results: Estimation of serum Troponin I and Myoglobin concentration showed that concentrations of Troponin I and Myoglobin were significantly higher (P<0.0001) in individuals infected with CoV-19 virus and unvaccinated higher than vaccinated with CoV-19 disease indicating the impact of the vaccine on the increment of both markers. However, the level of each marker was substantially higher (P<0.0001) in vaccinated with CoV-19 infection more than vaccinated without or recovered from COVID-19 illness.
Conclusions: The use of mRNA CoV-19 vaccination significantly modulate the increment of Troponin I and Myoglobin and improves the cardiac symptomatology in patients with CoV-19 infection.

Keywords:

COVID-19

Covid-19 vaccination

Troponin I

Myoglobin

Main Subjects:

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1. Ebashi S, Kodama A. A new protein factor promoting aggregation of tropomyosin. Biochemical and biophysical research communications. 2008 Apr 1;369(1):13-4. https://doi.org/10.1016/s0006-291x(08)00430-0

2. Jaffe AS, Landt Y, Parvin CA, Abendschein DR, Geltman EM, Ladenson JH. Comparative sensitivity of cardiac troponin I and lactate dehydrogenase isoenzymes for diagnosing acute myocardial infarction. Clinical chemistry. 1996 Nov 1;42(11):1770-6. https://doi.org/10.1093/clinchem/42.11.1770

3. Balk EM, Ioannidis JP, Salem D, Chew PW, Lau J. Accuracy of biomarkers to diagnose acute cardiac ischemia in the emergency department: a meta-analysis. Annals of emergency medicine. 2001 May 1;37(5):478-94. https://doi.org/10.1067/mem.2001.114905

4. Garg P, Morris P, Fazlanie AL, Vijayan S, Dancso B, Dastidar AG, Plein S, Mueller C, Haaf P. Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin. Internal and emergency medicine. 2017 Mar;12(2):147-55. https://doi.org/10.1007/s11739-017-1612-1

5. Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA, Tjora S, Domanski MJ, Gersh BJ, Rouleau JL, Pfeffer MA. A sensitive cardiac troponin T assay in stable coronary artery disease. New England Journal of Medicine. 2009 Dec 24;361(26):2538-47. https://doi.org/10.1056/NEJMoa0805299

6. Kanatous SB, Mammen PP. Regulation of myoglobin expression. Journal of Experimental Biology. 2010 Aug 15;213(16):2741-7. https://doi.org/10.1242/jeb.041442

7. Wittenberg JB, Wittenberg BA. Myoglobin function reassessed. Journal of experimental biology. 2003 Jun 15;206(12):2011-20.8. Millikan GA. Muscle hemoglobin. Physiol Rev. 1939;19(4):503–23. https://doi.org/10.1242/jeb.00243

9. Takahashi E, Doi K. Impact of diffusional oxygen transport on oxidative metabolism in the heart. The Japanese journal of physiology. 1998;48(4):243-52. https://doi.org/10.2170/jjphysiol.48.243

10. Williams RS. Regulation of gene expression in skeletal muscle by contractile activity. Handbook of Physiology section 12 Exercise. Regulation and Integration of Multiple Systems. The Amelical Physiol.. 1996:1124-50. https://doi.org/10.1016/S0021-9258(17)42482-3

11. Meeson AP, Radford N, Shelton JM, Mammen PP, DiMaio JM, Hutcheson K, Kong Y, Elterman J, Williams RS, Garry DJ. Adaptive mechanisms that preserve cardiac function in mice without myoglobin. Circulation research. 2001 Apr 13;88(7):713-20. https://doi.org/10.1161/hh0701.089753

12. Katus HA, Remppis A, Neumann FJ, Scheffold T, Diederich KW, Vinar G, Noe A, Matern G, Kuebler W. Diagnostic efficiency of troponin T measurements in acute myocardial infarction. Circulation. 1991 Mar;83(3):902-12. https://doi.org/10.1161/01.CIR.83.3.902

13. Ioannidis JP, Salem D, Chew PW, Lau J. Accuracy of imaging technologies in the diagnosis of acute cardiac ischemia in the emergency department: a meta-analysis. Annals of emergency medicine. 2001 May 1;37(5):471-7. https://doi.org/10.1067/mem.2001.114901

14. Covid CD, Team R, COVID C, Team R, Bialek S, Boundy E, Bowen V, Chow N, Cohn A, Dowling N, Ellington S. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. Morbidity and mortality weekly report. 2020 Mar 27;69(12):343. https://doi.org/10.15585/mmwr.mm6912e2

15. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nature reviews microbiology. 2019 Mar;17(3):181-92. https://doi.org/10.1038/s41579-018-0118-9

16. Wilder-Smith A. COVID-19 in comparison with other emerging viral diseases: risk of geographic spread via travel. Tropical Diseases, Travel Medicine and Vaccines. 2021 Dec;7(1):1-1. https://doi.org/10.1186/s40794-020-00129-9

17. Machhi J, Herskovitz J, Senan AM, Dutta D, Nath B, Oleynikov MD, Blomberg WR, Meigs DD, Hasan M, Patel M, Kline P. The natural history, pathobiology, and clinical manifestations of SARS-CoV-2 infections. Journal of Neuroimmune Pharmacology. 2020 Sep;15(3):359-86. https://doi.org/10.1007/s11481-020-09944-5

18. Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, Graham BS, McLellan JS. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020 Mar 13;367(6483):1260-3. https://doi.org/10.1126/science.abb2507

19. World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. Brazilian Journal Of Implantology And Health Sciences. 2020;2(3). https://doi.org/10.3389/fpsyg.2020.561270

20. Nascimento Junior JA, Santos AM, Quintans-Junior LJ, Walker CI, Borges LP, Serafini MR. SARS, MERS and SARS-CoV-2 (COVID-19) treatment: a patent review. Expert opinion on therapeutic patents. 2020 Aug 2;30(8):567-79.https://doi.org/10.1080/13543776.2020.1772231

21. Walker C, Deb S, Ling H, Wang Z. Assessing the elevation of cardiac biomarkers and the severity of COVID-19 infection: a meta-analysis. Journal of Pharmacy & Pharmaceutical Sciences. 2020 Oct 18;23:396-405. https://doi.org/10.18433/jpps31501

22. Pranata R, Huang I, Lim MA, Wahjoepramono EJ, July J. Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19–systematic review, meta-analysis, and meta-regression. Journal of stroke and cerebrovascular diseases. 2020 Aug 1;29(8):104949. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104949

23. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, Bi Z, Zhao Y. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical research in cardiology. 2020 May;109(5):531-8. https://doi.org/10.1007/s00392-020-01626-9

24. Ramadan MS, Bertolino L, Marrazzo T, Florio MT, Durante-Mangoni E. Cardiac complications during the active phase of COVID-19: review of the current evidence. Internal and Emergency Medicine. 2021 Nov;16(8):2051-61. https://doi.org/10.1007/s11739-021-02763-3

25. Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, Flament T, Ferreira-Maldent N, Bruyère F, Stefic K, Gaudy-Graffin C. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clinical Microbiology and Infection. 2021 Feb 1;27(2):258-63. https://doi.org/10.1016/j.cmi.2020.09.052

26. Ramadan MS, Bertolino L, Zampino R, Durante-Mangoni E, Iossa D, Ursi MP, D'Amico F, Karruli A, Ramadan M, Andini R, Bernardo M. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review. Clinical Microbiology and Infection. 2021 Sep 1;27(9):1250-61. https://doi.org/10.1016/j.cmi.2021.06.015

27. Khan S, Rasool ST, Ahmed SI. Role of cardiac biomarkers in COVID-19: what recent investigations tell us?. Current Problems in Cardiology. 2021 Oct 1;46(10):100842. https://doi.org/10.1016/j.cpcardiol.2021.100842

28. Dawson D, Dominic P, Sheth A, Modi M. Prognostic value of cardiac biomarkers in COVID-19 infection: a meta-analysis. Research square. 2020 Jun 13. https://doi.org/10.21203/rs.3.rs-34729/v1

29. Gomes AV, Potter JD, Szczesna‐Cordary D. The role of troponins in muscle contraction. IUBMB life. 2002 Dec;54(6):323-33. https://doi.org/10.1080/15216540216037

30. Ammirati E, Cavalotti C, Milazzo A, Pedrotti P, Soriano F, Schroeder JW, Morici N, Giannattasio C, Frigerio M, Metra M, Camici PG. Temporal relation between second dose BNT162b2 mRNA Covid-19 vaccine and cardiac involvement in a patient with previous SARS-COV-2 infection. International journal of cardiology. Heart & vasculature. 2021 Jun;34.https://doi.org/10.1016/j.ijcha.2021.100774

31. Mouch SA, Roguin A, Hellou E, Ishai A, Shoshan U, Mahamid L, Zoabi M, Aisman M, Goldschmid N, Yanay NB. Myocarditis following COVID-19 mRNA vaccination. Vaccine. 2021 Jun 29;39(29):3790-3. https://doi.org/10.1016/j.vaccine.2021.05.087

32. Gargano JW, Wallace M, Hadler SC, Langley G, Su JR, Oster ME, Broder KR, Gee J, Weintraub E, Shimabukuro T, Scobie HM. Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients: update from the Advisory Committee on Immunization Practices—United States, June 2021. Morbidity and Mortality Weekly Report. 2021 Jul 7;70(27):977. https://doi.org/10.15585/mmwr.mm7027e2

33. Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, Cooper Jr LT, Chahal CA. Recognizing COVID-19–related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart rhythm. 2020 Sep 1;17(9):1463-71. https://doi.org/10.1016/j.hrthm.2020.05.001

34. Muthukumar A, Narasimhan M, Li QZ, Mahimainathan L, Hitto I, Fuda F, Batra K, Jiang X, Zhu C, Schoggins J, Cutrell JB. In-depth evaluation of a case of presumed myocarditis after the second dose of COVID-19 mRNA vaccine. Circulation. 2021 Aug 10;144(6):487-98. https://doi.org/10.1161/CIRCULATIONAHA.121.056038

35. Majure DT, Gruberg L, Saba SG, Kvasnovsky C, Hirsch JS, Jauhar R, Northwell Health COVID-19 Research Consortium. Usefulness of elevated troponin to predict death in patients with COVID-19 and myocardial injury. The American journal of cardiology. 2021 Jan 1;138:100-6. https://doi.org/10.1016/j.amjcard.2020.09.060

36. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated troponin in patients with coronavirus disease 2019: possible mechanisms. Journal of cardiac failure. 2020 Jun 1;26(6):470-5. https://doi.org/10.1016/j.cardfail.2020.04.009

37. Ghaleb AA, Sadky A, Meghaizel MA, El Etriby S. Prognostic Value of Troponin I in COVID-19 Patients. The Open Cardiovascular Medicine Journal. 2021 Apr 19;15(1). https://doi.org/10.2174/1874192402115010018

38. Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, Cheng Y, Yan J, Ping H, Zhou Q. Suspected myocardial injury in patients with COVID-19: evidence from front-line clinical observation in Wuhan, China. International journal of cardiology. 2020 Jul 15;311:116-21. https://doi.org/10.1016/j.ijcard.2020.03.087

39. Kim CW, Aronow WS. COVID-19, cardiovascular diseases and cardiac troponins. Future Cardiology. 2021 Aug;18(2):135-42. https://doi.org/10.2217/fca-2021-0054

40. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, Jain SS, Burkhoff D, Kumaraiah D, Rabbani L, Schwartz A. COVID-19 and cardiovascular disease. Circulation. 2020 May 19;141(20):1648-55. https://doi.org/10.1161/CIRCULATIONAHA.120.046941

41. Apple FS, Wu AH, Sandoval Y, Sexter A, Love SA, Myers G, Schulz K, Duh SH, Christenson RH. Sex-specific 99th percentile upper reference limits for high sensitivity cardiac troponin assays derived using a universal sample bank. Clinical chemistry. 2020 Mar 1;66(3):434-44. https://doi.org/10.1093/clinchem/hvz029

42. Yang HS, Shemesh A, Li J, Xie T, Apple FS, Williams J, Zhao Z, Steel PA. No increase in the incidence of cardiac troponin I concentration above the 99th percentile by Siemens Centaur high-sensitivity compared to the contemporary assay. Clinical Biochemistry. 2021 Mar 1;89:77-80. https://doi.org/10.1016/j.clinbiochem.2020.12.001

43. D Little , MacGibbon A, Allen S, Posner X, and Keogh T 2022 “Myocarditis risk 17 times higher for unvaccinated patients ages 12-30 who get COVID-19 than COVID-vaccinated patients. https://doi.org/10.1097/01.cot.0000829172.30499.fb

44. Boehmer TK, Kompaniyets L, Lavery AM, Hsu J, Ko JY, Yusuf H, Romano SD, Gundlapalli AV, Oster ME, Harris AM. Association between COVID-19 and myocarditis using hospital-based administrative data—United States, March 2020–January 2021. Morbidity and Mortality Weekly Report. 2021 Sep 9;70(35):1228. https://doi.org/10.15585/mmwr.mm7035e5

45. Ling RR, Ramanathan K, Tan FL, Tai BC, Somani J, Fisher D, MacLaren G. Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis. The Lancet Respiratory Medicine. 2022 Apr 11. https://doi.org/10.1016/S2213-2600(22)00059-5

46. Flögel U, Merx MW, Gödecke A, Decking UK, Schrader J. Myoglobin: a scavenger of bioactive NO. Proceedings of the National Academy of Sciences. 2001 Jan 16;98(2):735-40. https://doi.org/10.1073/pnas.98.2.735

47. Alizadeh LS, Koch V, Yel I, Grünewald LD, Mathies D, Martin S, Vogl TJ, Rauschning D, Booz C. A case of Myocarditis after COVID-19 vaccination: Incidental or Consequential?. Heliyon. 2022 May 28:e09537. https://doi.org/10.1016/j.heliyon.2022.e09537

48. Lai FT, Li X, Peng K, Huang L, Ip P, Tong X, Chui CS, Wan EY, Wong CK, Chan EW, Siu DC. Carditis After COVID-19 Vaccination With a Messenger RNA Vaccine and an Inactivated Virus Vaccine: A Case–Control Study. Annals of internal medicine. 2022 Mar;175(3):362-70. https://doi.org/10.7326/M21-3700.

49. Ma C, Tu D, Gu J, Xu Q, Hou P, Wu H, Guo Z, Bai Y, Zhao X, Li P. The Predictive Value of Myoglobin for COVID-19-Related Adverse Outcomes: A Systematic Review and Meta-Analysis. Frontiers in cardiovascular medicine. 2021;8. https://doi.org/10.3389/fcvm.2021.757799

50. Fan ZX, Yang J, Zhang J, He C, Wu H, Yang CJ, Zheng T, Ma C, Xiang ZJ, Zhai YH, Jiang J. Analysis of influencing factors related to elevated serum troponin I level for COVID-19 patients in Yichang, China. Cardiovascular Diagnosis and Therapy. 2020 Aug;10(4):678. https://doi.org/10.21037/cdt-20-510

51. Özüdoğru O, Acer Ö, Genç Bahçe Y. Risks of catching COVID‐19 according to vaccination status of healthcare workers during the SARS‐CoV‐2 Delta variant dominant period and their clinical characteristics. Journal of Medical Virology. 2022 Apr 13. https://doi.org/10.1002/jmv.27778

52. Dionne A, Sperotto F, Chamberlain S, Baker AL, Powell AJ, Prakash A, Castellanos DA, Saleeb SF, de Ferranti SD, Newburger JW, Friedman KG. Association of myocarditis with BNT162b2 messenger RNA COVID-19 vaccine in a case series of children. JAMA cardiology. 2021 Dec 1;6(12):1446-50. https://doi.org/10.1001/jamacardio.2021.3471

53. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Marc GP, Moreira ED, Zerbini C, Bailey R. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. New England journal of medicine. 2020 Dec 10. https://doi.org/10.1056/NEJMoa2034577

54. Nassar M, Nso N, Gonzalez C, Lakhdar S, Alshamam M, Elshafey M, Abdalazeem Y, Nyein A, Punzalan B, Durrance RJ, Alfishawy M. COVID-19 vaccine-induced myocarditis: case report with literature review. Diabetes & metabolic syndrome. 2021 Sep;15(5):102205. https://doi.org/10.1016/j.dsx.2021.102205

55. Kim YJ, Bae JI, Ryoo SM, Kim WY. Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation. Acute and Critical Care. 2019 May 1;34(2):165-9. https://doi.org/10.4266/acc.2017.00045

56. Pepe S, Gregory AT, Denniss AR. Myocarditis, Pericarditis and Cardiomyopathy After COVID-19 Vaccination☆. Heart, Lung and Circulation. 2021 Oct 1;30(10):1425-9. https://doi.org/10.1016/j.hlc.2021.07.011

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