Background: Long Covid is associated with multi-organ inflammation, hypercoagulability, and several symptoms (fatigue, dyspnoea etc). Varying levels of cardiac involvement have been reported by cardiac magnetic resonance (CMR). We now describe longitudinal cardiovascular impairment in patients with Long Covid at 6 and 12 months post-SARS-CoV-2 infection.
Methods: 524 participants with Long Covid underwent a baseline scan at 6 months post infection (ClinicalTrials.gov: NCT04369807) and were rescanned 12 months post-infection if abnormal findings were reported at baseline. CMR (T1 and T2, cardiac mass, volumes, function, and strain), along with multi-organ MRI and blood samples were collected. Cardiovascular impairment was defined as one or more of: low left ventricular ejection fraction (LVEF), high left ventricular end diastolic volume (LVEDV), elevated native T1 in 3 or more cardiac segments. A significant longitudinal change was reported if greater than the repeatability coefficients derived from a population of 92 healthy controls.
Results: In 70 patients with cardiovascular impairment and Long Covid at baseline, 48 had complete paired data at 1 year, and of those 54% had not fully resolved. 19 (27%) patients with cardiovascular impairment had required hospitalization for acute COVID-19. Troponin or BNP were not predictive of CMR findings; however, hospitalization at the acute stage, male sex, kidney fibroinflammation and serum bicarbonate were. Individual symptoms were not specific to cardiovascular impairment or disease course.
Conclusion: CMR shows that cardiovascular impairment persists in Long Covid in some patients beyond 12 months post infection; however, this impairment may have pre-existing origin. Although there is an association with acute COVID-19 hospitalisation, male gender and high serum bicarbonate were predictive of cardiovascular impairment, subtypes of disease (based on symptoms, examination, and investigations) are yet to be established. Therefore, interventional trials with pre-specified subgroup analysis are required to inform therapeutic options.
Source: Roca-Fernandez A, Wamil M, Telford A, et al. CARDIOVASCULAR IMPAIRMENT IN LONG COVID ONE YEAR POST-SARS-COV-2 INFECTION. J Am Coll Cardiol. 2022 Mar, 79 (9_Supplement) 1312. https://doi.org/10.1016/S0735-1097(22)02303-8