Cardiac Involvement in Recovered Patients From COVID-19: A Preliminary 6-Month Follow-Up Study

Abstract

Background: Accumulating evidence has revealed that coronavirus disease 2019 (COVID-19) patients may be complicated with myocardial injury during hospitalization. However, data regarding persistent cardiac involvement in patients who recovered from COVID-19 are limited. Our goal is to further explore the sustained impact of COVID-19 during follow-up, focusing on the cardiac involvement in the recovered patients.Methods: In this prospective observational follow-up study, we enrolled a total of 40 COVID-19 patients (20 with and 20 without cardiac injury during hospitalization) who were discharged from Zhongnan Hospital of Wuhan University for more than 6 months, and 27 patients (13 with and 14 without cardiac injury during hospitalization) were finally included in the analysis. Clinical information including self-reported symptoms, medications, laboratory findings, Short Form 36-item scores, 6-min walk test, clinical events, electrocardiogram assessment, echocardiography measurement, and cardiac magnetic resonance imaging was collected and analyzed.Results: Among 27 patients finally included, none of patients reported any obvious cardiopulmonary symptoms at the 6-month follow-up. There were no statistically significant differences in terms of the quality of life and exercise capacity between the patients with and without cardiac injury. No significant abnormalities were detected in electrocardiogram manifestations in both groups, except for nonspecific ST-T changes, premature beats, sinus tachycardia/bradycardia, PR interval prolongation, and bundle-branch block. All patients showed normal cardiac structure and function, without any statistical differences between patients with and without cardiac injury by echocardiography. Compared with patients without cardiac injury, patients with cardiac injury exhibited a significantly higher positive proportion in late gadolinium enhancement sequences [7/13 (53.8%) vs. 1/14 (7.1%), p = 0.013], accompanied by the elevation of circulating ST2 level [median (interquartile range) = 16.6 (12.1, 22.5) vs. 12.5 (9.5, 16.7); p = 0.044]. Patients with cardiac injury presented higher levels of aspartate aminotransferase, creatinine, high-sensitivity troponin I, lactate dehydrogenase, and N-terminal pro–B-type natriuretic peptide than those without cardiac injury, although these indexes were within the normal range for all recovered patients at the 6-month follow-up. Among patients with cardiac injury, patients with positive late gadolinium enhancement presented higher cardiac biomarker (high-sensitivity troponin I) and inflammatory factor (high-sensitivity C-reactive protein) on admission than the late gadolinium enhancement–negative subgroup.Conclusions: Our preliminary 6-month follow-up study with a limited number of patients revealed persistent cardiac involvement in 29.6% (8/27) of recovered patients from COVID-19 after discharge. Patients with cardiac injury during hospitalization were more prone to develop cardiac fibrosis during their recovery. Among patients with cardiac injury, those with relatively higher cardiac biomarkers and inflammatory factors on admission appeared more likely to have cardiac involvement in the convalescence phase.

Quality of life of COVID 19 patients after discharge: Systematic review

“…1694 studies were excluded during the title and abstract screening, and 83 studies were screened at the full-text screening stage. The final systematic review included only 21 studies [ 11 – 31 ] ( Fig 1 ) and reasons for excluding full-texts were noted at the full-text screening stage.…”

“…Except for one study, all the other studies reported the mean age of the patients, and the age ranged from 41 to 74 years. Out of the total studies included, six studies [ 12 , 14 , 16 , 21 , 23 , 28 ] were from Italy, three [ 13 , 22 , 31 ] from China, two from Spain [ 19 , 27 ] and Norway [ 17 , 30 ], and one each from Brazil [ 29 ], Lithuania [ 26 ], Nederland [ 20 ], Germany [ 15 ], France [ 18 ], Sweden [ 24 ], and Iran [ 11 ]. Another study [ 25 ] has been conducted as a global online survey.…”

“…In the included studies, QOL was assessed using different tools, including the SF-36, SF-12, EQ-5D-5L, EQ-5D-3L, 15-D instrument and St George’s Respiratory questionnaire. The tools of SF-36 [ 13 , 17 , 22 , 24 , 26 , 28 , 31 ] and EQ-5D-5L [ 11 , 12 , 14 , 15 , 18 , 20 , 30 ] were used by seven studies, while EQ-5D-3L was used by four studies [ 21 , 25 , 27 , 29 ], SF-12 [ 19 ], and 15-D instrument [ 16 ] and St George’s Respiratory questionnaire [ 23 ] were used by one study. The assessment of QOL in the included studies was done at different stages following hospital discharge or recovery and it ranged from 15 days to six months.…”

“…The assessment of QOL in the included studies was done at different stages following hospital discharge or recovery and it ranged from 15 days to six months. Four studies assessed the QOL of discharged or recovered patients at the third [ 16 , 18 , 22 , 29 ] and the sixth months [ 15 , 27 , 30 , 31 ] respectively. Two studies assessed the QOL in the same group at two different times [ 12 , 14 ].…”

Cardiac involvement in COVID-19: cause or consequence of severe manifestations?

“…Morphological and functional parameters (LVEF, cardiac output, cardiac index and ventricular volumes) and native T1 measurements were similar, but a higher proportion of late gadolinium enhancement (7 of 13 vs 1 of 14) was observed in those with myocardial injury, especially in the LV septum and RV insertion points. 8 However, a direct analogy with the present study is not possible, in the absence of a risk-factor matched group.…”