Article Impact Level: HIGH Data Quality: STRONG Summary of Nature Medicine, 28(10), 2117–2123. https://doi.org/10.1038/s41591-022-02000-0 Dr. Valentina Puntmann et al
Points
- As COVID-19’s late consequences, persistent cardiac symptoms such as arrhythmias, generalized weakness, and chest pain are increasingly identified.
- Hospitalized individuals with pre-existing diseases frequently have myocardial damage, which is indicated by increased troponin and is associated with greater rates of heart issues and a poor prognosis.
- Significant troponin increases are uncommon in home-bound, non-hospitalized patients with mild initial illness and no history of heart disease.
- Studies conducted primarily in young, active individuals shortly after the initial infection found non-ischemic cardiac scarring, pericarditis, and mild myocardial inflammatory alterations.
Summary
As many as 30% of people may experience unique, reoccurring, or persistent health issues for many weeks after having SARS-CoV-2.1 So-called protracted COVID may manifest in people with a wide range of initial symptoms, from asymptomatic infection to serious illness. Some of the main cardiovascular symptoms are, however, chest discomfort, dyspnea, and palpitations.
Because the pathophysiology of this syndrome is not well understood, the authors sought to learn more about the possible causes of protracted cardiovascular symptoms in this population group.
In this single-center observational trial, 346 people who had a moderate SARS-CoV-2 infection in the past but no known cardiovascular disease were prospectively tracked with serial assessments of cardiovascular biomarkers and cardiac magnetic resonance imaging (CMR). A 95-person sample of predominantly asymptomatic, uninfected people was used for comparison. A median of 109 and 329 days following diagnosis with COVID-19, respectively, were spent on the initial evaluation and reassessment of patients with prior SARS-CoV-2 infection who reported cardiac symptoms.
Symptomatic people were more likely to exhibit imaging evidence of myocardial inflammation and pericardial enhancement by CMR. However, biomarker evidence of myocardial injury/inflammation and signs of structural heart disease was rarely found.
Diffuse myocardial edema was more frequently seen in patients at follow-up who had symptoms. Additionally, myocardial involvement at baseline determined by CMR and female gender independently predicted follow-up cardiac symptoms.
The observed results suggest that ongoing cardiovascular inflammation by CMR may explain the persistence of some cardiac symptoms after SARS-CoV-2 infection, despite the study’s numerous limitations (such as its single-center design, the possibility of selection bias due to self-referral recruitment, and its small sample size).
It is hoped that the continuing National Institutes of Health Recover initiative will contribute to the much-needed illumination of this subject because there is still much to learn about the epidemiology, underlying mechanisms, and predisposing risk factors for chronic COVID.
Link to the article: https://www.nature.com/articles/s41591-022-02000-0
References Puntmann, V. O., Martin, S., Shchendrygina, A., Hoffmann, J., Ka, M. M., Giokoglu, E., Vanchin, B., Holm, N., Karyou, A., Laux, G. S., Arendt, C., De Leuw, P., Zacharowski, K., Khodamoradi, Y., Vehreschild, M. J. G. T., Rohde, G., Zeiher, A. M., Vogl, T. J., Schwenke, C., & Nagel, E. (2022). Long-term cardiac pathology in individuals with mild initial COVID-19 illness. Nature Medicine, 28(10), 2117–2123. https://doi.org/10.1038/s41591-022-02000-0
