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Cardiac Involvement Due to COVID-19: Insights from Imaging and Histopathology

Valentina O Puntmann1, Anastasia Shchendrygina1, Carlos Rodriguez Bolanos1

  • 1Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany.

European Cardiology
|November 9, 2023
PubMed

Insights

Post-acute cardiovascular sequelae of COVID-19 (PASC) cause lingering heart problems, affecting both those with prior heart conditions and previously healthy individuals. Recognizing and diagnosing these complex cardiovascular syndromes is crucial for patient outcomes.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to persistent cardiac symptoms, termed post-acute cardiovascular sequelae (PASC).
  • Acute cardiac injury in COVID-19 is linked to cytokine release, ischemia, and thrombosis, particularly impacting patients with pre-existing heart disease.
  • Myocarditis from direct viral infection is uncommon; chronic PASC involves either exacerbation of existing cardiovascular disease or a distinct inflammatory syndrome.

Purpose of the Study:

  • To highlight the growing recognition of post-acute cardiovascular sequelae (PASC) following SARS-CoV-2 infection.
  • To differentiate between PASC presentations: worsening of pre-existing cardiovascular disease versus a new cardiovascular syndrome driven by immune dysregulation.
  • To underscore the challenges in clinical recognition and management of PASC and the need for improved diagnostic tools.

Main Methods:

  • Review of current understanding of cardiac complications following SARS-CoV-2 infection.
  • Analysis of the mechanisms driving acute cardiac injury and chronic PASC presentations.
  • Discussion of clinical implications, diagnostic needs, and management challenges for PASC.

Main Results:

  • PASC encompasses two main phenotypes: exacerbation of pre-existing cardiovascular disease and a novel cardiovascular syndrome linked to immune dysregulation.
  • Both PASC presentations are associated with elevated cardiovascular risk, long-term disability, and diminished quality of life.
  • The latter PASC phenotype affects a significant number of individuals who were previously in good health.

Conclusions:

  • Effective clinical recognition and management of PASC remain significant challenges.
  • There is a critical need for sensitive diagnostic methods to identify subtle inflammatory changes in PASC-cardiovascular syndrome.
  • Enhanced clinical expertise in managing inflammatory cardiac conditions is essential for addressing PASC.

Keywords:
COVID-19PASCcardiovascular magnetic resonancemyocardial injurymyocarditispost-acute sequelae of COVID-19

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