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Elevated Risk of Long-Term Decline in Left Ventricular Ejection Fraction After COVID-19

Roham Hadidchi1, Ekram Ali1, Hannah Piskun1

  • 1Department of Radiology Montefiore Health System and Albert Einstein College of Medicine Bronx NY USA.

Journal of the American Heart Association
|October 14, 2025
PubMed

Insights

COVID-19 survivors face a higher risk of long-term left ventricular ejection fraction (LVEF) decline, particularly those hospitalized. Cardiac monitoring is crucial for these patients to prevent further heart dysfunction.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • COVID-19 is linked to cardiovascular complications, but long-term effects on left ventricular function remain unclear.
  • Investigating the association between SARS-CoV-2 infection and left ventricular ejection fraction (LVEF) decline is critical.

Purpose of the Study:

  • To determine if SARS-CoV-2 infection increases the risk of LVEF decline.
  • To assess if COVID-19 vaccination mitigates the risk of LVEF decline.

Main Methods:

  • Retrospective study of patients with COVID-19 and normal baseline LVEF (≥50%) with follow-up echocardiograms (2016-2024).
  • Outcomes included LVEF decline to <50%, <40%, and <30%.
  • Multivariable Cox models adjusted for demographics, comorbidities, vaccination status, and baseline LVEF.

Main Results:

  • COVID-19 patients had lower mean follow-up LVEF and higher rates of LVEF decline compared to controls.
  • Both hospitalized and non-hospitalized COVID-19 patients showed increased risk of LVEF <50%. Hospitalized patients had significantly higher risk of LVEF <40% and <30%.
  • Vaccination status was not significantly associated with LVEF decline. Biomarkers like troponin and D-dimer predicted greater risk in hospitalized patients.

Conclusions:

  • SARS-CoV-2 infection is associated with long-term LVEF declines, especially in hospitalized individuals.
  • Vigilant cardiac surveillance is recommended for COVID-19 survivors to mitigate progressive cardiac dysfunction.
Abstract

Keywords:
acute cardiac injuryechocardiogramheart failurelong COVIDmyocardial infarction

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