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Laboratory and Imaging Evaluation of Cardiac Involvement in Patients with Post-Acute COVID-19
Ersin Sarıçam1,2, Ali Doğan Dursun3,4, Gülçin Türkmen Sarıyıldız5,6
1Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey.
Insights
Post-acute COVID-19 syndrome can cause heart issues. Biomarkers like NT-proBNP and nitric oxide (NO), along with cardiac PET scans, help identify cardiac fatigue and potential heart failure risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomarkers
Background:
- Post-acute COVID-19 syndrome presents with cardiac symptoms like palpitations and fatigue.
- The exact mechanisms of cardiac involvement in post-acute COVID-19 remain unclear.
- Identifying cardiac involvement is crucial for managing long-term patient health.
Purpose of the Study:
- To investigate potential causes of cardiac involvement in post-acute COVID-19.
- To utilize biomarkers (NT-proBNP, nitric oxide) and advanced cardiac imaging for assessment.
- To differentiate cardiac status between symptomatic and asymptomatic post-COVID-19 patients.
Main Methods:
- A cross-sectional study included 105 participants (20-50 years old) with and without post-COVID-19 symptoms.
- Biochemical analysis included NT-proBNP, Troponin I, and nitric oxide (NO) levels.
- Cardiac imaging utilized echocardiography, cardiovascular magnetic resonance (CMR), and cardiac positron emission tomography (PET).
Main Results:
- Symptomatic patients exhibited significantly higher NT-proBNP levels (p < 0.001).
- Symptomatic patients showed significantly lower nitric oxide (NO) levels (p < 0.001).
- Cardiac PET revealed increased 18F-FDG uptake, indicative of myocardial fatigue, while echocardiography and CMR were normal.
Conclusions:
- Elevated NT-proBNP, low serum NO, and increased cardiac PET 18F-FDG uptake are observed in post-acute COVID-19 syndrome.
- Cardiac PET may be valuable for detecting subacute/chronic myocarditis, potentially complementing or replacing CMR.
- Monitoring post-acute COVID-19 patients should consider the risk of developing heart failure.
Background:
In the post-acute COVID-19 syndrome, many patients suffer from palpitations, effort-associated fatigue, and even sudden death. The mechanism of heart involvement in this syndrome is uncertain. The main purpose of the study was to identify possible cardiac involvement causes in patients with post-acute COVID-19 by using biomarkers such as NT-proBNP and nitric oxide (NO) and cardiac imaging modalities.
Methods:
In this cross-sectional study, a total of 105 participants were included according to the existence of symptoms, and 40 of these participants were asymptomatic patients. The ages of the participants ranged from 20 to 50 years. All patients were healthy before COVID-19. The symptoms were defined as palpitations and/or fatigue association with exercise in post-acute COVID-19 term. The comparison of the two groups was made by using biochemical parameters (NT-proBNP, Troponin I, NO) and imaging techniques (echocardiography, cardiovascular magnetic resonance (CMR) and cardiac positron emission tomography (PET)).
Results:
The symptomatic patients had higher NT-proBNP levels compared with asymptomatic patients (132.30±35.15; 76.86±16.79, respectively; p < 0.001). Interestingly, the symptomatic patients had lower NO levels than asymptomatic patients (9.20±3.08; 16.15±6.02, respectively; p < 0.001). Echocardiography and CMR were normal. However, we found regional increased 18F-FDG uptake on cardiac PET to be compatible with myocardial fatigue.
Conclusion:
We found elevated NT-proNBP levels, low serum NO levels, and increased 18F-FDG uptake on cardiac PET in post-acute COVID syndrome. Cardiac PET could replace or be added to CMR for detecting subtle subacute/chronic myocarditis. The follow-up of patients with post-acute COVID-19 could target the possibility of risk of heart failure.
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