Cardiovascular disease as part of Long COVID: a systematic review

Abstract

Background Long COVID syndrome has had a major impact on million patients’ lives worldwide. The cardiovascular system is an important aspect of this multifaceted disease that may manifest in many ways. We have hereby performed a narrative review in order to identify the extent of the cardiovascular manifestations of the Long COVID syndrome. Methods and Results An in-depth systematic search of the literature has been conducted for this narrative review. The systematic search of PubMed and Cochrane databases yielded 3,993, of which 629 underwent full text screening. A total of 78 studies were included in the final qualitative synthesis and data evaluation. The pathophysiology of the cardiovascular sequelae of Long COVID syndrome and the cardiac manifestations and complications of Long COVID syndrome are critically evaluated. In addition, potential cardiovascular risk factors are assessed, and preventive methods and treatment options are examined in this review. Conclusions This systematic review poignantly summarises the evidence from the available literature regarding the cardiovascular manifestations of Long COVID syndrome and reviews potential mechanistic pathways, diagnostic approaches, preventive measures and treatment options.

Pathogenic mechanisms of cardiovascular damage in COVID-19

“…About 45% of COVID-19 survivors experienced persistent symptoms at 4 months post the acute infection (O'Mahoney et al 2022;Tsampasian et al 2024;Adu-Amankwaah 2024). Systematic review confirms that chest pain, palpitations, dyspnoea, and syncope are the most commonly symptoms among patients with long COVID syndrome (Tsampasian et al 2024). The patients with underlying cardiac disease or the presence of cardiovascular disease risk factors are more likely to experience serious outcomes (Tian et al 2020).…”

“…Myocardial involvement may be a feature of long COVID syndrome from the early months of the COVID-19 pandemic (Tsampasian et al 2024). About 45% of COVID-19 survivors experienced persistent symptoms at 4 months post the acute infection (O'Mahoney et al 2022;Tsampasian et al 2024;Adu-Amankwaah 2024). Systematic review confirms that chest pain, palpitations, dyspnoea, and syncope are the most commonly symptoms among patients with long COVID syndrome (Tsampasian et al 2024).…”

“…Therefore, the clinical presentations of COVID-19 are multifaceted and vary widely, mainly include the general features of respiratory infection and the special manifestations of extrapulmonary complications such as cardiovascular, cerebrovascular, gastrointestinal, musculoskeletal, endocrine, and renal systems. Many patients with COVID-19 can develop different types of cardiovascular complications during hospitalization (Pellicori et al 2021), which may be a part of post-acute infection sequelae (Tsampasian et al 2024). Approximately 62% of the COVID-19 hospitalized patients had acute myocardial injuries (Shu et al 2023).…”

“…Approximately 62% of the COVID-19 hospitalized patients had acute myocardial injuries (Shu et al 2023). Myocardial involvement may be a feature of long COVID syndrome from the early months of the COVID-19 pandemic (Tsampasian et al 2024). About 45% of COVID-19 survivors experienced persistent symptoms at 4 months post the acute infection (O'Mahoney et al 2022;Tsampasian et al 2024;Adu-Amankwaah 2024).…”

“…The patients with underlying cardiac disease or the presence of cardiovascular disease risk factors are more likely to experience serious outcomes (Tian et al 2020). The clinical manifestations of cardiovascular damage in COVID-19 patients include myocarditis and pericarditis, hypertension, arrhythmia, myocardial injury and heart failure, coronary heart disease (CHD), stress cardiomyopathy, ischemic stroke, blood coagulation abnormalities, and dyslipidemia (Adu-Amankwaah et al 2021;Zhao et al 2023;Tsampasian et al 2024;Fig. 3).…”