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We report three patients who presented with chest pain after receiving either the BNT162b2 Pfizer/BioNTech or mRNA-1273 Moderna/NIH vaccine. Clinical presentation, biomarker, and cardiac MRI supported myocarditis. It is imperative that potential side effects of COVID-19 vaccine are reported to improve our knowledge about COVID-19 and mRNA vaccines.

Objective To examine the long-term effects of standard chemotherapy on myocardial function in asymptomatic breast cancer survivors using two-dimensional speckle tracking echocardiography. Methods Seventy women (chemotherapy group) aged 5468 years who had received anthracycline treatment with (n¼19) or without (n¼51) adjuvant trastuzumab up to 6 years previously, and 50 female controls were studied. Left ventricular systolic (ejection fraction (EF%), peak systolic myocardial excursion, (Sm)) and diastolic (peak mitral E and A velocities, six-point average of mitral annular E 9 velocities) function, 2D global and regional longitudinal and radial strain were determined using standard 2D Doppler and tissue Doppler echocardiographic methods and speckle tracking software. Results Despite normal EF% (6264% vs 6063%, p¼0.051) the chemotherapy group had reduced E/A ratios (0.960.3 vs 1.160.3, p¼0.003), global E 9 (10.262 vs 11.262.3, p¼0.036), global Sm (9.061.3 vs 9.661.3, p¼0.029) and global longitudinal 2D strain (� 18.162.2 vs � 19.661.8, p¼0.0001) in comparison with controls. In 18 (26%) of the chemotherapy group, global longitudinal strain was below the lower limit of the control group. Cigarette smoking was a negative predictor of longitudinal strain, but only in the chemotherapy group. Radial strain did not differ significantly between the two groups. There were no significant differences in EF%, global Sm and longitudinal strain between trastuzumab-treated individuals and controls. Conclusions Subclinical systolic and diastolic myocardial abnormalities were present in asymptomatic breast cancer survivors up to 6 years after standard chemotherapy. Cigarette smoking had a negative effect on longitudinal strain in these individuals. Adjuvant trastuzumab treatment did not appear to have an additive adverse impact on myocardial function in the mediumelong term.

Summary To estimate the cost and diagnostic implications of using CMR alone instead of conventional TTE/TMET work-up to guide patient selection for angiography. Healthcare costs were derived from VHI’s hospital billing system. Background Patient selection for coronary angiography traditionally relies on clinical assessment, treadmill exercise testing (TMET) and transthoracic echocardiography (TTE). Cardiac Magnetic Resonance (CMR) is a relatively novel imaging study, which provides excellent non-invasive assessment of myocardial perfusion and is useful in risk stratification of patients with suspected coronary artery disease (CAD). Methods

Summary Aims To study an asymptomatic group of HIV positive men on antiretroviral drugs and compare them to age and sex matched controls in order to detect underlying cardiovascular disease. Background The increased survival associated with the advent of antiretroviral therapy (ART) for HIV in the mid-1990s has been accompanied by an increase in cardiovascular comorbidity and mortality. Atherothrombosis, myocardial disease, hypertension, diabetes, and pulmonary hypertension have been identified as entities associated with treated disease and the risk of major cardiovascular events is higher than in the uninfected population. HIV patients on ART are at higher risk of developing left ventricular (LV) systolic dysfunction, and more recent studies have additionally demonstrated significantly higher levels of diastolic dysfunction and LV hypertrophy to controls. Methods Methods: Prospective cohort study of asymptomatic HIV positive men on antiretroviral drugs. Baseline demographics, routine biochemistry, fasting lipids and glucose were recorded. A resting 12 lead ECG was taken on all participants. Patients were scanned on a 3T Philips machine with standard protocols as per SCMR guidelines and received weight based intravenous gadolinium. Controls were age and sex matched. Post analysis software was used for LV function, mass and wall thickness. Diastolic function was assessed using phase contrast analysis of mitral inflow to calculate e:a ratio. Results 30 HIV positive men were compared with 13 male healthy controls. Mean age for cases vs controls was 50.3 years (+/-9years) vs 41.7 (+/- 6.5 years) respectively. Established cardiovascular risk was prevalent in the HIV population at higher rates than controls: cigarette smoking 35%, hypertension on treatment 29.4%, hyperlipidaemia 44.1% with 29.4% on statin therapy vs 0% of controls who smoked, had hypertension or were on statin treatment. HIV patients had a higher rate of diastolic dysfunction, had greater prevalence of increased wall thickness and had more abnormalities detected, both cardiac and non-cardiac(see table 1). Conclusions In this asymptomatic population of HIV positive men we found an increased incidence of silent myocardial infarction and increased wall thickness. There was also an increase in diastolic dysfunction compared to age matched controls. These data will be expanded to further investigate whether these findings are due to the effects of long term antiretroviral therapy or as a result of increased prevalence of established cardiovascular risks in this patient cohort. Funding