COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors

Abstract

Up to 20%-30% of patients hospitalized with coronavirus disease 2019 (COVID-19) have evidence of myocardial involvement. Acute cardiac injury in patients hospitalized with COVID-19 is associated with higher morbidity and mortality. There are no data on how acute treatment of COVID-19 may affect the convalescent phase or longterm cardiac recovery and function. Myocarditis from other viral pathogens can evolve into overt or subclinical myocardial dysfunction, and sudden death has been described in the convalescent phase of viral myocarditis. This raises concerns for patients recovering from COVID-19. Some patients will have subclinical and possibly overt cardiovascular abnormalities. Patients with ostensibly recovered cardiac function may still be at risk of cardiomyopathy and cardiac arrhythmias. Screening for residual cardiac involvement in the convalescent phase for patients recovered from COVID-19-associated cardiac injury is needed. The type of testing and therapies for post COVID-19 myocardial dysfunction will need to be determined. Therefore, now is the time to plan for appropriate registries and clinical trials to properly assess these issues and prepare for long-term sequelae of "post-COVID-19 cardiac syndrome."

BCG vaccination early in life does not improve COVID‐19 outcome of elderly populations, based on nationally reported data

“…Upon admission to hospital, 92% of patients have symptoms, and 8% are asymptomatic (Mei et al 2020). Another 60% (range 40-80%) will have a range of mild symptoms (Chen et al 2020a), but even so might be incurring serious organ damage that will haunt them later in life (Mitrani et al 2020). Another roughtly 10-25% of cases will have severe to critical symptoms resulting in pneumonia leading to acute respiratory distress (ARDS), coagulopathies, and a form of hyperactive immune response termed a cytokine storm (Ragab et al 2020;Mangalmurti and Hunter 2020;Guan et al 2020;Guo et al 2020).…”

Attributes and predictors of Long-COVID: analysis of COVID cases and their symptoms collected by the Covid Symptoms Study App

“…Asthma was the only/unique pre-existing condition providing significant association with long-COVID-19 (OR = 2.14 [1.55-2.96]). Relapse in the context of long-COVID was longer than in the matched controls (median = 9 [5-18] vs 6 [4][5][6][7][8][9][10] days).…”

Re-Opening Exercise Science Laboratories and Testing During the Covid-19 Endemic Phase

“…Similarly, asking if, within the past 14 days, the individual has been exposed to someone with a known positive test for SARS-COV-2 or they themselves have tested positive for SARS-COV-2 should be implemented. Depending on the severity of COVID-19, an individual may be at higher risks for cardiovascular complications during exercise due to cardiac injury [16] or vascular damage [17]. These added risks should be taken into consideration and discussed with subjects prior to testing.…”