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Cardiovascular Manifestations of Patients with Long COVID

Gordana Krljanac1,2, Milika Asanin1,2, Mihajlo Viduljevic1

  • 1Clinic of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.

Diagnostics (Basel, Switzerland)
|July 29, 2025
PubMed

Insights

Long COVID frequently causes heart problems, including inflammation-driven structural and functional changes. Multimodality imaging helps detect these cardiovascular issues for timely treatment.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Long COVID, a condition following SARS-CoV-2 infection, presents with persistent symptoms impacting various organ systems.
  • Cardiovascular manifestations are increasingly recognized as a significant sequela of long COVID.
  • Understanding the underlying mechanisms of cardiac involvement is crucial for patient management.

Purpose of the Study:

  • To investigate the mechanisms of cardiac structural and functional changes in patients with long COVID.
  • To identify cardiovascular phenotypes associated with long COVID.
  • To assess the utility of multimodality imaging in characterizing cardiac involvement.

Main Methods:

  • Study included 176 outpatients with long COVID symptoms exceeding 12 weeks.
  • Echocardiography was performed to assess left ventricular ejection fraction (LVEF) and myocardial strain (longitudinal and circumferential).
  • Cardiac magnetic resonance (CMR) imaging, including late gadolinium enhancement (LGE) and T1/T2 mapping, was utilized to evaluate cardiac pathology.

Main Results:

  • Patients with long COVID and cardiovascular manifestations experienced higher hospitalization rates and longer stays.
  • Significant echocardiography findings included reduced LVEF, impaired longitudinal and circumferential strain, and altered CS PSS.
  • CMR revealed pathological findings in 58.2% of patients, with prevalent LGE, elevated native T1, and elevated native T2 mapping.

Conclusions:

  • Long COVID frequently leads to cardiovascular structural and functional alterations, predominantly due to persistent inflammation.
  • Multimodality imaging is essential for identifying mechanisms, predicting conditions like chronic myocarditis and early heart failure.
  • Early recognition of cardiovascular phenotypes in long COVID is critical for effective and timely therapeutic interventions.

Keywords:
COVID-19cardiovascular diseasesechocardiographylong COVIDmultimodality imaging

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