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The authors of this prospective, single-center, observational study conducted serial cardiac assessments by measuring cardiac biomarkers and performing cardiovascular MRI to evaluate the underlying pathophysiology leading to cardiac symptoms in people with COVID-19 who had no previous cardiac disease or notable comorbidities. At baseline, 73% of the participants reported cardiac symptoms, and symptomatic individuals were more likely to have evidence of inflammatory cardiac involvement on imaging or biomarker assessment. At follow-up (329 days after COVID-19 diagnosis), 53% had persistent cardiac symptoms, and diffuse myocardial edema was more pronounced in those who remained symptomatic.
These findings suggest that subclinical myocardial inflammation may contribute to lingering cardiac symptoms in previously healthy individuals with mild initial COVID-19. Targeted surveillance strategies are necessary for patients with persistent exertional symptoms following COVID-19 to ensure timely diagnosis and recognition of chronic cardiac pathology.
Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear. In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77-177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%). Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals. At follow-up (329 days (IQR, 274-383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up. Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.
Long-term cardiac pathology in individuals with mild initial COVID-19 illness
Nat. Med. 2022 Sep 05;[EPub Ahead of Print], VO Puntmann, S Martin, A Shchendrygina, J Hoffmann, MM Ka, E Giokoglu, B Vanchin, N Holm, A Karyou, GS Laux, C Arendt, P De Leuw, K Zacharowski, Y Khodamoradi, MJGT Vehreschild, G Rohde, AM Zeiher, TJ Vogl, C Schwenke, E Nagel