Recent research strongly supports the suspicion that persistent myocardial damage in patients with myocarditis secondary to Covid vaccines has a very poor prognosis. A standard heart condition marker (LGE) bodes very badly for those diagnosed with myocarditis, for those deemed to be recovered as well as for the many more not picked up by ‘passive surveillance’, presaging a massive increase of heart illness in coming years. Dr Rafael Bornstein reports on the latest evidence for this looming tragedy.
NEVER in the history of medicine, which over the last hundred years or so has been based on a rational approach to disease, has there been such a flagrant attack on the fundamental principles of clinical practice as during the recent Covid pandemic. The result of delivering Covid-19 mRNA ‘vaccines’ to billions of people without proven evidence of efficacy and safety has yet to be fully revealed in its true severity.
The already huge number of serious adverse effects is, I fear, but the tip of the iceberg. At the moment we are seeing an ice floe at best, but evidence is emerging that short- to long-term cardiac effects of the ‘vaccine’ will affect millions of victims in the years to come. Tragically it will be mostly the current young who are doomed to become prey to the deadly effects of the Covid vaccines.
Symptomatic acute myocarditis following the administration of Covid-19 mRNA vaccines has been downplayed by health and medical authorities worldwide. Although documented as a severe adverse event occurring mainly in young men a few days after vaccination, the authorities reassure themselves it is rare.
Indeed, using ‘passive surveillance’, myocarditis associated with the BNT162b2-mRNA (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines can be presented as a rare event, whose incidence ranges between 4 and 7 cases and 9 and 28 cases per 100,000 respectively. But anyone reassured by this needs to understand that passive surveillance detects only the most severe cases requiring hospitalisation and agreed to be vaccine-related. It does not pick up the myocardial injury that escapes passive surveillance, where symptoms are unacknowledged as vaccine-related, or may be unspecific, mild or even absent. With the administration of repeated booster vaccinations to billions worldwide to date, knowledge of true incidence and precise prognostic of mRNA-vaccine-associated subclinical myocardial injury – damage to a vital organ that cannot be repaired by myocardial regeneration from surrounding healthy tissue – becomes of major importance to predict.
Dr Mueller and colleagues at the University Hospital Basel in Switzerland have been engaged in this task. They have conducted a prospective active surveillance study to address this central unmet need. They have been able to provide significant data on the actual incidence of mRNA-1273 vaccination-associated subclinical myocardial injury, measured by the acute dynamic increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration above the upper limit of normal on day 3 after vaccination without evidence of an alternative cause. Hospital employees scheduled to undergo mRNA-1273 booster vaccination were assessed. Among 777 participants (median age 37 years), mRNA-1273 vaccine-associated subclinical myocardial injury was adjudicated in 22 participants (2.8 per cent) out of 40 showing elevated day 3 hs-cTnT concentration. This shows an incidence of subclinical myocardial injury of two orders of magnitude above the risk of acute myocarditis (1 in 35 vs 9 to 28 in 100,000). Furthermore, this enlightening study demonstrated that nearly 100 per cent of vaccinated hospital employees also showed some degree of mRNA-1273 vaccine-associated myocardial damage on day 3, verified by a slight but significant deviation in hs-cTnT concentration (although within normal range) at higher levels relative to unvaccinated matched controls. In other words, myocardial tissue seems to be universally damaged by mRNA vaccination, leading to acute symptomatic myocarditis in the most extreme cases or to a less severe lesion much more prevalent (100 to 300 times at least) for which the prognosis is currently unknown.
The main finding of this study in Switzerland has been confirmed and generalised in two other studies of complementary cohorts, of healthcare workers in Israel and of adolescents in Thailand, after vaccination with the BNT162b2-mRNA booster vaccination, which showed that subclinical myocardial injury associated with mRNA vaccines is indeed more common than estimated on passive surveillance.
At this moment of time the long-term consequences of acute myocarditis and subclinical myocardial injury following Covid-19 vaccination remain unknown. Reported short-term clinical trajectory after Covid-19 vaccine-associated myocarditis with resolution of cardiac symptoms and normalisation of ventricular function in most patients, appear reassuring, but long-term cardiovascular outcomes remain uncertain. Cases of relapsing myocarditis after initial recovery from the first episode following vaccination have recently been reported in two adolescent male patients. This challenges the official benign prognosis in myocarditis.
Since the elevation in cTnT levels in subclinical myocardial injury is transient and mostly mild, suggesting an apparently small degree of acute cardiomyocyte injury, good long-term results might in principle be expected. However, faced with the substantial long-term mortality reported in patients with myocarditis of autoimmune or viral origin (19.2 per cent at five years and 39.3 per cent at ten years), a more worrying prognosis cannot be ruled out.
Further studies are urgently needed to assess the impact of mRNA vaccine-associated myocarditis and subclinical myocardial injury on the lifelong risk of malignant arrhythmias, heart failure and eventually cardiac death in higher than expected numbers among the vaccinated.
Of utmost relevance to this point is research undertaken by Hong Kong Children’s Hospital and published just over a month ago into the cardiovascular outcomes at one year after Covid-19 vaccine-associated myocarditis in adolescent patients. Their electrocardiographic, echocardiographic, and cardiac magnetic resonance (CMR) findings at diagnosis and at latest follow-up (5.6 – 12.3 months) were reviewed. Forty patients aged 13 to 18 were included. Although nonehad cardiac arrhythmias, angina, heart failure or ECG abnormalities at latest follow-up, and 95 perc ent of patients had normal left ventricular function on echocardiographic evaluation, the follow-up of the 26 patients with abnormal CMR findings at presentation, including features of myocarditis in 22 and late gadolinium enhancement (LGE) in 19, revealed residual LGE at one year in 16 cases (40 per cent of the entire series).
A similar multicentre study conducted in Italy in 2019 evaluated 187 patients with acute myocarditis who, whatever the cause, also showed LGE persistence six months after onset in an even higher proportion (73 per cent). This indicates that irreversible myocardial damage following acute myocarditis as evidenced by LGE is a significant and concerning adverse event, probably affecting more than half of patients. In fact, the subset of patients with persistent LGE in this study had a much worse prognosis, with a mortality rate as high as 40 per cent at seven years.
Gadolinium-based contrast agents are multicompartmental molecules that move from the capillaries to the interstitial space with rapid wash-in but slower wash-out, typically completed within five to eight minutes of the injection. Conditions that enlarge the interstitial space, such as replacement fibrosis, oedema, and protein overload, increase the volume of distribution of gadolinium in the myocardium and produce much slower wash-out (up to ten minutes or more after injection), detectable as LGE on CMR. LGE denotes tissue inflammation and early fibrosis, reversible in some cases. But when LGE persists, the finding is generally considered a marker of irreversible myocardial damage. This permanent myocardial dysfunction caused by irreversible fibrosis favours re-entry circuits and plays a key role in the genesis of ventricular arrhythmias and sudden cardiac death.
Therefore, it would not be surprising that LGE persistence for months may represent a worse prognosis for the majority of patients with Covid-19 vaccine-associated myocarditis. LGE has been shown to be the most powerful independent predictor of outcome, with a hazard ratio of 8.4 for all-cause mortality and 12.8 for cardiac mortality. As shown before, a ten-year follow-up of patients with acute myocarditis showed an overall mortality rate of 39.3 per cent, which is a two-fold increase over the five-year mortality rate of 19.2 per cent, suggesting that the risk of death from myocarditis remains constant throughout life.
In a systematic review and meta-analysis published in 2021, persistence of LGE is associated with a three-fold increased risk of a composite endpoint (all-cause mortality, cardiac mortality, and major adverse cardiovascular events). Furthermore, the presence of LGE not only predicts outcome, but the extent and anatomic location of LGE are also significantly associated with a worse prognosis. In at least two previously published large studies, anteroseptal location, midwall distribution, and patchy pattern of LGE demonstrate the strongest significant associations with major adverse cardiovascular events (MACE). Anteroseptal location of LGE portended a twofold increased risk of dying or experiencing MACE compared with non-anteroseptal LGE. This is hypothesised to be the result of involvement of the cardiac conduction system, creating a substrate for malignant arrhythmias.
This medical appraisal of myocardial injuries associated to Covid-19 mRNA vaccines, presents a far more disturbing scenario than that described repeatedly from the beginning by the health authorities and the mass media. Referring to these adverse effects of Covid-19 vaccines as infrequent and generally benign is not consistent with reality. As we have just seen, the five-year and ten-year mortality rates of acute myocarditis associated with Covid-19 mRNA vaccines could well be expected to be nearly 20 and 40 per cent respectively, with even higher rates due to LGE persistence in more than half of patients.
As more than 5billion people (almost 13.5billion doses delivered) have already been vaccinated worldwide (65 per cent of the global population), and considering an approximate 3:1 ratio in the number of Pfizer and Moderna vaccines administered, it can be estimated that 110,000 to 350,000 vaccinated people will suffer from acute myocarditis. From these, between 44,000 and 140,000 will die in ten years.
If we look at the entire iceberg, these figures may still be only the minimal expression of a much more terrifying future. As has been shown, symptomatic acute myocarditis is just ‘the tip of the iceberg’ of the 100 to 300 times more prevalent subclinical myocardial damage caused by mRNA vaccines. In the worst-case scenario, if these patients with apparently less severe myocardial injury (up to 140million, 2.8 per cent of 5billion) had such high rates of LGE persistence and so unfavourable a prognosis as acute myocarditis, the number of deaths in the coming years could amount to dizzying figures: 28million in five years and 56million in ten years.
The key question is how sound these projections are. To this end, the results of a study evaluating the impact of asymptomatic perioperative myocardial injury (PMI) in patients undergoing non-cardiac surgery are clearly revealing. Two thousand and eighteen consecutive patients included were monitored with serial hs-cTnT measurements before and after surgery. PMI was defined as an absolute increase in hs-cTnT of ≥14 ng/L from preoperative to postoperative measurements. PMI occurred in 397 patients and was accompanied by typical chest pain or any ischemic symptoms in 96. Mortality at one year was 22.5 per cent (versus 9.3 per cent in patients without PMI). Most importantly, patients with asymptomatic PMI had poor long-term outcomes comparable to patients with myocardial injury who met additional criteria of acute myocardial infarction.
Therefore, in the perioperative setting, subclinical myocardial damage is as harmful as myocardial injury with chest pain or ischemic symptoms. Presumably, this equivalent unfavourable outcome could also be expected for patients with acute myocarditis or with subclinical myocardial injury associated with Covid-19 mRNA vaccines. Thus, the expectations indicated above that millions of people could die in the coming years are not at all far-fetched. In fact, these devastating effects of vaccines are already allegedly responsible in part for the very high and excessive mortality rates around the world.
In Spain we usually say ‘blanco y en botella, leche’ (crystal clear in English) when something is very obvious. What would I do if I were in charge of my country’s medicines regulatory agency? Obviously, I wouldn’t state that Covid-19 vaccines have saved millions of lives around the world based on estimates constructed through biased mathematical models. Instead, I would obviously not dismiss the data presented here and would convey enormous concerns about the horrendous estimates of millions of deaths caused by vaccines. Obviously, I would immediately order the suspension of the vaccination campaign and promote in-depth research that positively determines the role of the spike protein on the myocardial injury after Covid-19 vaccination, whether there is a causal relationship between the mRNA vaccines and these serious adverse effects and their long-term prognosis. Finally, I would not authorise any vaccine until it is firmly and unequivocally established that the benefits of vaccination clearly outweigh the risks.
Health regulators who fail to take into account the enormous risks posed by Covid-19 vaccines are leading our countries directly into the abyss.