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Losartan and prednisolone for post-COVID syndrome and cardiac inflammation: a randomized, double-blind,

Valentina O Puntmann1,2, Eike Nagel3,4,5, Dietrich Beitzke6

  • 1DZHK Centre for Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research - Partner Site Rhein-Main, Goethe University Frankfurt, Frankfurt am Main, Germany. puntmann@med.uni-frankfurt.de.

Nature Communications
|July 30, 2026
PubMed

Insights

This clinical trial found no significant improvement in left ventricular ejection fraction for post-COVID inflammatory cardiac syndrome treated with losartan and prednisolone. The treatment was safe but did not meet the primary endpoint for cardiac function.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Persistent cardiac symptoms are frequent in post-COVID syndrome, linked to immune dysregulation and inflammation.
  • Existing treatments for inflammatory cardiac involvement in post-COVID syndrome are lacking.
  • Cardiovascular magnetic resonance identifies inflammatory cardiac involvement.

Purpose of the Study:

  • To evaluate the efficacy of losartan plus prednisolone versus placebo in treating inflammatory cardiac involvement in post-COVID syndrome.
  • To assess the impact of the intervention on left ventricular ejection fraction and other cardiac parameters.

Main Methods:

  • A multicenter, double-blind, randomized clinical trial (Myoflame-19) involving 279 participants.
  • Participants received either losartan plus prednisolone or matching placebos for 16 weeks.
  • The primary endpoint was the change in left ventricular ejection fraction, assessed via cardiovascular magnetic resonance.

Main Results:

  • The treatment demonstrated a neutral effect on the primary endpoint (change in left ventricular ejection fraction).
  • Secondary endpoints showed numerical improvements in symptoms and imaging, but confidence intervals included the null value.
  • The intervention was safe and well-tolerated by participants.

Conclusions:

  • Losartan plus prednisolone did not significantly improve left ventricular ejection fraction in patients with inflammatory cardiac involvement post-COVID-19.
  • Findings suggest the need for further research into targeted immunomodulation for post-COVID cardiac complications.
  • The study provides valuable data for designing future clinical trials in this patient population.

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