Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review
Mohammad Said Ramadan1, Lorenzo Bertolino1, Rosa Zampino2
1Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
Insights
COVID-19 survivors may experience persistent heart issues, including subclinical myocardial injury and diastolic dysfunction. Further research is needed to fully understand the long-term cardiac impact of coronavirus disease 2019.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) is linked to various cardiac problems post-infection.
- Understanding these cardiac sequelae is crucial for patient management.
Purpose of the Study:
- To systematically review and assess the spectrum of cardiac sequelae following COVID-19 recovery.
- To identify common cardiac abnormalities and risks in survivors.
Main Methods:
- Systematic review of 35 studies (52,609 patients) published up to February 17, 2021.
- Inclusion of prospective, retrospective studies, case reports, and series.
- Cardiac assessments included cardiac magnetic resonance imaging (CMR), echocardiography, ECG, and biomarkers.
Main Results:
- Short-term abnormalities (<3 months) included increased T1/T2 on CMR, pericardial effusion, and symptoms like chest pain and dyspnea.
- Medium-term changes (3-6 months) showed reduced left ventricular strain, diastolic dysfunction, and elevated N-terminal proB-type natriuretic peptide.
- COVID-19 survivors had a 3-fold increased risk of heart failure, arrhythmias, and myocardial infarction.
Conclusions:
- COVID-19 is associated with persistent or new cardiac injury after recovery.
- Subclinical myocardial injury is noted early, followed by diastolic dysfunction later.
- Larger, well-designed studies with baseline data are required to quantify cardiac injury extent and clinical significance.
Background:
Coronavirus disease 2019 (COVID-19) has been implicated in a wide spectrum of cardiac manifestations following the acute phase of the disease.
Objectives:
To assess the range of cardiac sequelae after COVID-19 recovery.
Data Sources:
PubMed, Embase, Scopus (inception through 17 February 2021) and Google scholar (2019 through 17 February 2021).
Study Eligibility Criteria:
Prospective and retrospective studies, case reports and case series.
Participants:
Adult patients assessed for cardiac manifestations after COVID-19 recovery.
Exposure:
Severe acute respiratory syndrome coronavirus 2 infection diagnosed by PCR.
Methods:
Systematic review.
Results:
Thirty-five studies (fifteen prospective cohort, seven case reports, five cross-sectional, four case series, three retrospective cohort and one ambidirectional cohort) evaluating cardiac sequelae in 52 609 patients were included. Twenty-nine studies used objective cardiac assessments, mostly cardiac magnetic resonance imaging (CMR) in 16 studies, echocardiography in 15, electrocardiography (ECG) in 16 and cardiac biomarkers in 18. Most studies had a fair risk of bias. The median time from diagnosis/recovery to cardiac assessment was 48 days (1-180 days). Common short-term cardiac abnormalities (<3 months) included increased T1 (proportion: 30%), T2 (16%), pericardial effusion (15%) and late gadolinium enhancement (11%) on CMR, with symptoms such as chest pain (25%) and dyspnoea (36%). In the medium term (3-6 months), common changes included reduced left ventricular global longitudinal strain (30%) and late gadolinium enhancement (10%) on CMR, diastolic dysfunction (40%) on echocardiography and elevated N-terminal proB-type natriuretic peptide (18%). In addition, COVID-19 survivors had higher risk (risk ratio 3; 95% CI 2.7-3.2) of developing heart failure, arrythmias and myocardial infarction.
Conclusions:
COVID-19 appears to be associated with persistent/de novo cardiac injury after recovery, particularly subclinical myocardial injury in the earlier phase and diastolic dysfunction later. Larger well-designed and controlled studies with baseline assessments are needed to better measure the extent of cardiac injury and its clinical impact.
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