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While long-term COVID holds many mysteries, researchers have found clues to common cardiac symptoms in these patients, suggesting that persistent inflammation is a mediator.
In a cohort of 346 previously healthy COVID-19 patients, most of whom remained symptomatic after a median of about 4 months, elevations in biomarkers of structural heart disease and cardiac injury or dysfunction were rare.
But there are many signs of subclinical heart problems, report Valentina O. Puntmann, MD, University Hospital Frankfurt, Germany, and her colleagues at Nature Medicine.
Compared to uninfected controls, COVID patients had significantly higher diastolic blood pressure, significantly increased non-ischemic myocardial scarring due to late gadolinium enhancement, detectable non-hemodynamically related pericardial effusion, and pericardial effusion. <0,001). <0.001).
In addition, 73% of COVID-19 patients with cardiac symptoms had higher cardiac MRI (CMR) mapping values ​​than asymptomatic individuals, indicating diffuse myocardial inflammation and greater accumulation of pericardial contrast.
“What we’re seeing is relatively benign,” Puntmann told MedPage Today. “These are previously normal patients.”
In contrast to what is commonly thought to be a heart problem with COVID-19, these results provide insight that patients with pre-existing heart problems are more likely to be hospitalized with serious illness and consequences.
Puntman’s group studied people without heart problems to try to understand the impact of COVID-19 itself, using research-grade MRI images of patients recruited to their clinics through family doctors, health authority centers, promotional materials distributed by patients online. Groups and websites. .
Puntmann noted that while this is a select group of patients who may not generally represent mild cases of COVID-19, it is not uncommon for these patients to seek answers to their symptoms.
Federal survey data shows that 19 percent of American adults infected with COVID had symptoms for 3 months or longer after infection. In the current study, follow-up scans an average of 11 months after COVID-19 diagnosis showed persistent heart symptoms in 57% of participants. Those who remained symptomatic had more diffuse myocardial edema than those who recovered or never had symptoms (natural T2 37.9 vs 37.4 and 37.5 ms, P = 0.04).
“Heart involvement is an important part of the long-term manifestations of COVID — hence dyspnea, effort intolerance, tachycardia,” Pontman said in an interview.
Her group concluded that the cardiac symptoms they observed were “associated with a subclinical inflammatory lesion of the heart, which may explain, at least in part, the pathophysiological basis of persistent cardiac symptoms. Notably, severe myocardial injury or structural heart disease is not a pre-existing condition and the symptoms do not fit the classical definition of viral myocarditis.”
Cardiologist and long-term COVID patient Alice A. Perlowski, MD, pointed out the important clinical implications by tweeting: “This study illustrates how traditional biomarkers (in this case CRP, muscle calcin, NT-proBNP) may not tell the whole story.” . , #LongCovid, I hope that all clinicians who see these patients in practice address this critical point.”
Among 346 adults with COVID-19 (mean age 43.3 years, 52% women) screened at one center between April 2020 and October 2021, at a median of 109 days after exposure, the most common cardiac symptom was shortness of breath exercise (62%), palpitations (28%), atypical chest pain (27%), and syncope (3%).
“Knowing what’s going on with routine heart tests is a challenge because it’s hard to spot very abnormal conditions,” Puntmann said. “Part of it has to do with the pathophysiology behind it… Even if their function is compromised, it’s not that dramatic because they compensate with tachycardia and a very excited heart. Therefore, we did not see them in the decompensated phase.”
The team plans to continue to follow these patients over the long term to understand what the potential clinical implications might be, fearing that it “may herald a major burden of heart failure years down the road,” according to the center’s website. The team also initiated the MYOFLAME-19 placebo-controlled study to test anti-inflammatory drugs and drugs that act on the renin-angiotensin system in this population.
Their study included only patients with no previously known heart disease, comorbidities, or abnormal lung function tests at baseline and who had never been hospitalized for acute COVID-19.
An additional 95 patients at the clinic who did not have prior COVID-19 and had no known heart disease or comorbidities were used as controls. While the researchers acknowledged that there may be unrecognized differences compared to COVID patients, they noted a similar distribution of risk factors by age, gender, and cardiovascular disease.
Among patients with COVID symptoms, the majority were mild or moderate (38% and 33%, respectively), and only nine (3%) had severe symptoms that limited daily activities.
Factors independently predicting cardiac symptoms from baseline scan to rescan at least 4 months later (median 329 days after diagnosis) were female gender and diffuse myocardial involvement on baseline.
“Notably, because our study focused on individuals with pre-COVID disease, it did not report the prevalence of post-COVID heart symptoms,” Puntman’s group wrote. “However, it provides important information about their spectrum and subsequent evolution.”
Puntmann and co-author disclosed speaking fees from Bayer and Siemens, as well as educational grants from Bayer and NeoSoft.
Source citation: Puntmann VO et al “Long-term cardiac pathology in individuals with mild onset COVID-19 disease”, Nature Med 2022; DOI: 10.1038/s41591-022-02000-0.
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