Symptom Persistence Despite Improvement in Cardiopulmonary Health – Insights from longitudinal CMR, CPET and lung function testing post-COVID-19

Cassar, Mark Philip; Tunnicliffe, Elizabeth M; Petousi, Nayia; Lewandowski, Adam J.; Xie, Cheng; Mahmod, Masliza; Samat, Azlan Helmy Abd; Evans, Rachael A.; Brightling, Christopher; Ho, Ling-Pei; Piechnik, Stefan K.; Talbot, Nick P.; Holdsworth, David; Ferreira, Vanessa M.; Neubauer, Stefan; Raman, Betty

doi:10.1016/j.eclinm.2021.101159

Cited by 103 publications

(153 citation statements)

References 54 publications

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“… 35 and Cassar et al . 36 Varying definitions of long COVID may also affect the relative frequencies. Mahmud et al .…”

Section: Long Covid and Epidemiology Of Cardiac Symptomsmentioning

confidence: 99%

“…Numerous studies have evaluated the role of 12-lead electrocardiogram (ECG) in screening patients for post-acute cardiac manifestations, 36 , 103 , 117 , 124 , 136 although commonly pre-COVID-19 control ECGs are missing. Dynamic ECG changes (e.g.…”

Section: Post-acute Covid-19 Cardiovascular Sequelaementioning

confidence: 99%

“…depolarization, repolarization abnormalities, arrhythmias) 137 , 138 while frequent during acute illness, tend to resolve in the majority of hospitalized patient by 6 months post-acute COVID-19 and are often comparable to risk-factor matched controls. 36 , 103 , 117 , 136 Nevertheless, sinus arrhythmia is frequent in the post-acute phase and manifests as transient or sustained periods of sinus tachycardia or bradycardia. 103–105 In a study of 234 patients, Radin et al observed that 13.7% of patients wearing a Fitbit displayed persistently elevated heart rate (>5 beats above the pre-COVID baseline resting heart rate) up to 133 days post-infection.…”

Section: Post-acute Covid-19 Cardiovascular Sequelaementioning

confidence: 99%

“… 125 , 160 , 161 When the acute infection abates, 161 right ventricular abnormalities improve in most patients. 36 , 125 Left ventricular systolic dysfunction is comparatively less frequent. 101 , 125 Follow-up echo and CMR studies have confirmed that even among those with severe acute infection 125 or elevated troponin, 101 systolic impairment is rare, affecting up to 9–11% of patients.…”

Section: Post-acute Covid-19 Cardiovascular Sequelaementioning

confidence: 99%

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Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus

Raman

Bluemke

Lüscher

et al. 2022

European Heart Journal

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403

318

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Emerging as a new epidemic, long COVID or post-acute sequelae of coronavirus disease 2019 (COVID-19), a condition characterized by the persistence of COVID-19 symptoms beyond 3 months, is anticipated to substantially alter the lives of millions of people globally. Cardiopulmonary symptoms including chest pain, shortness of breath, fatigue, and autonomic manifestations such as postural orthostatic tachycardia are common and associated with significant disability, heightened anxiety, and public awareness. A range of cardiovascular (CV) abnormalities has been reported among patients beyond the acute phase and include myocardial inflammation, myocardial infarction, right ventricular dysfunction, and arrhythmias. Pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiac diseases which are abundant in those at risk of severe disease. In this review, we discuss the definition of long COVID and its epidemiology, with an emphasis on cardiopulmonary symptoms. We further review the pathophysiological mechanisms underlying acute and chronic CV injury, the range of post-acute CV sequelae, and impact of COVID-19 on multiorgan health. We propose a possible model for referral of post-COVID-19 patients to cardiac services and discuss future directions including research priorities and clinical trials that are currently underway to evaluate the efficacy of treatment strategies for long COVID and associated CV sequelae.

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“… 35 and Cassar et al . 36 Varying definitions of long COVID may also affect the relative frequencies. Mahmud et al .…”

Section: Long Covid and Epidemiology Of Cardiac Symptomsmentioning

confidence: 99%

Section: Post-acute Covid-19 Cardiovascular Sequelaementioning

confidence: 99%

Section: Post-acute Covid-19 Cardiovascular Sequelaementioning

confidence: 99%

Section: Post-acute Covid-19 Cardiovascular Sequelaementioning

confidence: 99%

See 2 more Smart Citations

Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus

Raman

Bluemke

Lüscher

et al. 2022

European Heart Journal

Self Cite

403

318

View full text Add to dashboard Cite

show abstract

“… 111 , 151 , 152 , 153 Cardiac evaluation in these patients may also fail to identify a specific etiology for their reported symptoms. 154 , 155 , 156 , 157 , 158 Collectively, this can be a source of tremendous frustration for patients and clinicians alike and may lead to significant variation in care.…”

Section: Description Of Pathwaymentioning

confidence: 99%

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Gluckman¹,

Bhave²,

Allen³

et al. 2022

Journal of the American College of Cardiology

271

273

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Pulmonary Manifestations of “Long COVID” (Post–COVID-19)

Demeter¹

2022

AMA Guides® Newsletter

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) infections began in late 2019/early 2020 and quickly achieved pandemic proportions. Of significance is that, while most individuals recover, some do not. Those who have persistent symptoms are diagnosed with long COVID, or post-COVID syndrome. Individuals with long COVID develop symptoms related to multiple organ systems. One of the more frequent systems affected is the pulmonary system. Individuals develop shortness of breath and/or fatigue. These are sometimes unrelated to any abnormalities on physiological or radiographic testing. More frequently, however, there are abnormalities found radiographically (especially on computed tomography) and on physiological testing (generally, abnormalities in the diffusion capacity for carbon monoxide or in a 6-minute walk test with the oxygen saturation being measured during the test). This article reviews many published articles and is organized by the duration of signs, symptoms, and/or testing abnormalities after the initial diagnosis of COVID-19. The date of maximum medical improvement is suggested to be 12 months, although currently this cannot be definitively supported. More time will need to pass so that appropriate data can be collected.

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Symptom Persistence Despite Improvement in Cardiopulmonary Health – Insights from longitudinal CMR, CPET and lung function testing post-COVID-19

Cited by 103 publications

References 54 publications

Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus

Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Pulmonary Manifestations of “Long COVID” (Post–COVID-19)

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