COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors
Raul D Mitrani1, Nitika Dabas1, Jeffrey J Goldberger1
1Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Insights
Many COVID-19 patients experience heart issues, with potential long-term cardiac dysfunction and arrhythmias. Further research is crucial to understand and manage these "post-COVID-19 cardiac syndrome" risks.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- A significant percentage of hospitalized coronavirus disease 2019 (COVID-19) patients exhibit myocardial involvement.
- Acute cardiac injury in COVID-19 is linked to increased morbidity and mortality.
- Limited data exist on the impact of acute COVID-19 treatment on long-term cardiac recovery.
Purpose of the Study:
- To highlight the need for screening for residual cardiac involvement in the convalescent phase of COVID-19.
- To emphasize the potential for long-term cardiac sequelae, including cardiomyopathy and arrhythmias.
- To advocate for the establishment of registries and clinical trials to assess post-COVID-19 cardiac syndrome.
Main Methods:
- This study is a review and expert opinion piece.
- It synthesizes existing knowledge on viral myocarditis and COVID-19 cardiac injury.
- It identifies gaps in current understanding and proposes future research directions.
Main Results:
- COVID-19 can lead to acute cardiac injury with significant implications.
- Viral myocarditis can have long-term consequences, raising concerns for COVID-19 survivors.
- Subclinical and overt cardiovascular abnormalities may persist post-recovery.
Conclusions:
- There is a critical need for screening and monitoring of cardiac function in COVID-19 survivors.
- Further research is required to determine appropriate testing and therapies for post-COVID-19 myocardial dysfunction.
- Proactive planning for registries and trials is essential to address the long-term cardiac sequelae of COVID-19.
Abstract:
Up to 20%-30% of patients hospitalized with coronavirus disease 2019 (COVID-19) have evidence of myocardial involvement. Acute cardiac injury in patients hospitalized with COVID-19 is associated with higher morbidity and mortality. There are no data on how acute treatment of COVID-19 may affect the convalescent phase or long-term cardiac recovery and function. Myocarditis from other viral pathogens can evolve into overt or subclinical myocardial dysfunction, and sudden death has been described in the convalescent phase of viral myocarditis. This raises concerns for patients recovering from COVID-19. Some patients will have subclinical and possibly overt cardiovascular abnormalities. Patients with ostensibly recovered cardiac function may still be at risk of cardiomyopathy and cardiac arrhythmias. Screening for residual cardiac involvement in the convalescent phase for patients recovered from COVID-19-associated cardiac injury is needed. The type of testing and therapies for post COVID-19 myocardial dysfunction will need to be determined. Therefore, now is the time to plan for appropriate registries and clinical trials to properly assess these issues and prepare for long-term sequelae of "post-COVID-19 cardiac syndrome."
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