Long-term cardiac pathology in individuals with mild initial COVID-19 illness, 2022, Puntmann et al

Long-term cardiac pathology in individuals with mild initial COVID-19 illness
Valentina O. Puntmann, Simon Martin, Anastasia Shchendrygina, Jedrzej Hoffmann, Mame Madjiguène Ka, Eleni Giokoglu, Byambasuren Vanchin, Niels Holm, Argyro Karyou, Gerald S. Laux, Christophe Arendt, Philipp De Leuw, Kai Zacharowski , Yascha Khodamoradi, Maria J. G. T. Vehreschild, Gernot Rohde, Andreas M. Zeiher, Thomas J. Vogl, Carsten Schwenke, Eike Nagel

Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear.

In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77–177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%).

Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals.

At follow-up (329 days (IQR, 274–383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up.

Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.

Link | PDF (Nature Medicine)

 

Is this a description of viral myocarditis, which can cause a range of symptoms from asymptomatic to heart failure.? Numerous viruses cause viral myocarditis but it is never been investigated in mild patients.

One study of RSV showed that 50% of the children at asymptomatic MRI changes.

 

No.

 

Significant, but unlikely to be a major cause of the main PEM population given how widely fluctuating it is. Spontaneous remissions, even if temporary and partial, don't work well with any structural damage.

It could be a significant driver of fatigue, but is very unlikely to explain most of the symptoms, especially systemic neurological and GI symptoms.

 

Yes, I think it's another window into what's happening in the cardiovascular system more generally (emphasis on vascular rather than cardiac), esp endothelial dysfunction. Similar to the observations via xenon-MRI lung studies showing what might be happening with the lung vasculature. Agree this doesn't encompass the immunometabolic side of things, but neuro/GI could be mostly secondary to vascular disruption: blood-brain barrier -> neuroinflammation/microglial activation and loss of mucosal barrier integrity, respectively.