A study published yesterday in JAMA has the skeptical cardiologist very concerned about the long-term cardiac effects of COVID-19 infection.
The investigators performed cardiac MRI (CMR) on 100 patients with documented COVID-19. Cardiac MRI is now considered the gold-standard for noninvasively measuring pathologic changes in cardiac muscle.
In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.
These patients were evaluated a mean of 71 days after confirmed COVID-19 diagnosis,
Note that left ventricular ejection fraction (LVEF), the most common measure of the systolic or pumping function of the heart although lower in the COVID-19 patients was not depressed below normal values. This means these cardiac abnormalities would not be detected on more commonly available cardiac diagnostic methods like echocardiography.
Also note that risk-factor matched controls have a fair number of CMR abnormalities and that we don’t know what cardiac MRI would show in a comparison group of patients recovering from the flu.
Despite these limitations, given reports of ongoing cardiac symptoms in many post-COVID-19 patients, I have to agree with these words from an accompanying JAMA editorial.
We wish not to generate additional anxiety but rather to incite other investigators to carefully examine existing and prospectively collect new data in other populations to confirm or refute these findings. We hope these findings represent that of a select cohort of patients. Yet, if this high rate of risk is confirmed, the pathologic basis for progressive left ventricular dysfunction is validated, and especially if longitudinal assessment reveals new-onset heart failure in the recovery phase of COVID-19, then the crisis of COVID-19 will not abate but will instead shift to a new de novo incidence of heart failure and other chronic cardiovascular complication
Gadoliniumly Yours,
-ACP