Key result
SARS-CoV-2 linked to persistent subclinical myocardial changes and elevated CV risk at 1 year despite preserved LVEF.
Why the study?
COVID-19 is linked to persistent cardiovascular sequelae, but the trajectory of structural and functional cardiac changes beyond the acute phase remains unclear.
What are the longitudinal structural and functional cardiac changes assessed by imaging and biomarkers in adults ≥ 12 weeks post-SARS-CoV-2 infection?
Systematic Review (n=166,000)
What are the longitudinal structural and functional cardiac changes assessed by imaging and biomarkers in adults ≥ 12 weeks post-SARS-CoV-2 infection?
While gross systolic function generally recovers post-COVID-19, subclinical myocardial changes and elevated cardiovascular risk can persist up to 1 year, supporting the need for risk-stratified follow-up.
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Supports risk-stratified follow-up in symptomatic survivors; extends acute-phase data to persistent subclinical injury at 1 year.
COVID-19 has been linked to persistent cardiovascular sequelae, yet the trajectory of structural and functional cardiac changes beyond the acute phase remains unclear. This systematic review synthesizes longitudinal evidence on post-COVID cardiac remodeling assessed by imaging and biomarkers. Following PRISMA guidelines, we searched PubMed and Cochrane Library (January 2020-April 2025) for peer-reviewed studies enrolling adults (≥18 years) with polymerase chain reaction (PCR)/antigen-confirmed SARS-CoV-2 infection and reporting cardiac outcomes ≥ 12 weeks post-infection. Eligible outcomes included imaging-based abnormalities (cardiac magnetic resonance [CMR]: T1/T2 mapping, late gadolinium enhancement [LGE]; echocardiography: left ventricular ejection fraction [LVEF], LV/RV strain). Longitudinal trends of biomarkers (troponin, NT-proBNP, C-reactive protein [CRP]) were also studied. Risk of bias was assessed using joanna briggs institute (JBI) tools; synthesis followed synthesis without metaanalysis (SWiM) principles. Fifteen studies (n ≈ 166,000; 14 cohorts, 1 case report) were included. Across CMR cohorts, global systolic function was largely preserved, but tissue abnormalities were frequent early and improved over time: edema indices normalized by ~ 12 months, while LGE prevalence declined (e.g. 50%→19% in paired scans). However, residual non-ischemic scars and elevated T1/T2 persisted in symptomatic subgroups. Echocardiography showed normal LVEF, but subtle left ventricular global longitudinal strain (LV-GLS) impairment versus controls (e.g. -18.5% vs - 19.3%). Biomarker trends were heterogeneous: natriuretic peptide positivity persisted in patients with prior cardiovascular disease (CVD), while troponin and CRP generally normalized. Large population-based cohorts demonstrated sustained 12-month risk for heart failure, myocarditis, and major cardiovascular events, graded by acute severity. Most patients recover gross systolic function, yet subclinical myocardial changes and elevated population-level cardiovascular risk persist up to 1 year. These findings support risk-stratified follow-up, judicious use of advanced imaging, and preventive cardiology strategies.
Abid et al. (2026) conducted a systematic review in Post-COVID-19 cardiac remodeling (n=166,000). SARS-CoV-2 infection vs. Controls was evaluated on Imaging-based abnormalities (CMR, echocardiography) and longitudinal trends of biomarkers. SARS-CoV-2 infection is associated with persistent subclinical myocardial changes (LGE declining from 50% to 19%) and elevated cardiovascular risk up to 1 year, despite preserved systolic function.
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