Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

Abstract

Background Coronavirus disease 2019 (COVID-19) has been implicated in a wide spectrum of cardiac manifestations following the acute phase of the disease. Objectives To assess the range of cardiac sequelae after COVID-19 recovery. Data sources PubMed, Embase, Scopus (inception through 17 February 2021), and Google scholar (2019 through 17 February 2021). Study eligibility criteria Prospective and retrospective studies, case reports and case series. Participants Adult patients assessed for cardiac manifestations after COVID-19 recovery. Exposure Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosed by polymerase chain reaction (PCR). Methods Systematic review. Results Thirty-five studies (fifteen prospective cohort, seven case reports, five cross-sectional, four case series, three retrospective cohort and one ambidirectional cohort) evaluating cardiac sequelae in 52609 patients were included. Twenty-nine studies utilized objective cardiac assessments, mostly cardiac magnetic resonance imaging (CMR) in sixteen studies, echocardiography in fifteen, electrocardiography (ECG) in sixteen and cardiac biomarkers in eighteen. Most studies had a fair risk of bias. The median time from diagnosis/recovery to cardiac assessment was 48 days (1-180). Common short-term cardiac abnormalities (<3 months) included increased T1 (proportion: 30%), T2 (16%), pericardial effusion (15%) and late gadolinium enhancement (LGE, 11%) on CMR, with symptoms such as chest pain (25%) and dyspnea (36%). In the medium term (3-6 months), common changes included reduced left ventricular global longitudinal strain (30%) and LGE (10%) on CMR, diastolic dysfunction (40%) on echocardiography and elevated NT-proBNP (18%). In addition, COVID-19 survivors had higher risk (RR = 3; 95% CI: 2.7-3.2) of developing heart failure, arrythmias and myocardial infarction. Conclusions COVID-19 appears to be associated with persistent/de novo cardiac injury after recovery, particularly subclinical myocardial injury in the earlier phase and diastolic dysfunction later. Larger well-designed and controlled studies with baseline assessments are needed to better measure the extent of cardiac injury and its clinical impact.

Investigating the Relationship between Vitamin D and Persistent Symptoms Following SARS-CoV-2 Infection

“…Symptom burden appears to be independent of the severity of initial infection, with no clear predictors of who will develop ongoing symptoms [10]. Persistent endothelial dysfunction may be responsible for the wide variation in symptoms reported [11][12][13]. There is also some evidence suggesting that altered inflammatory cytokine pathways may persist during convalescence [14].…”

Pericarditis after SARS-CoV-2 Infection: Another Pebble in the Mosaic of Long COVID?

“…A myocarditis-pattern was observed up to 30 days after SARS-CoV-2 infection in the 27% of 148 patients in the UK who had myocardial injury [ 11 ]. Data on pericardial involvement are scarce, and a recent systematic literature review (SLR) including studies on adult patients undergoing any type of cardiac assessment after COVID-19 recovery reported a prevalence of pericardial enhancement in 63/758 patients and of pericardial effusion in 99/758 patients (on cardiac magnetic resonance (CMR)) or 12/811 patients (on echocardiography) [ 12 ]. Unfortunately, only four studies on CMR included in the SLR reported a formal clinical diagnosis of myopericarditis (15/785 patients) and pericarditis (4/785 patients), while only one study using echocardiography reported a formal clinical diagnosis of pericarditis [ 13 ].…”

Acute and Chronic Effects of COVID-19 on the Cardiovascular System

“…Cardiovascular manifestations in the post-acute phase of COVID-19 described in the studies so far have ranged from asymptomatic changes in CMR exploration to symptoms of heart failure, including palpitations, tightness, dizziness, and chest pain. The frequency of them varied greatly between different reports [95][96][97]. Most of these studies were observational and without a control arm in some cases.…”

“…However, there are still many questions regarding the pathophysiologic mechanisms and the real implications of imaging findings of the acute and post-acute phase on the longterm prognosis. Studies suggested that patients who have recovered from COVID-19 will present a greater risk for a range of cardiac diseases, including heart failure, myocardial infarction (MI), and arrhythmia in the mid-and long-term [95].…”