What is the clinical evidence from this study?

Study design: Observational. Population: Mild initial COVID-19 illness (n=441). Intervention: Mild initial COVID-19 illness vs. Controls without previous infection / Asymptomatic COVID-19 participants. Primary outcome: Presence of cardiac symptoms at follow-up (predicted by baseline native T1 per 10 ms increase) (OR 1.13, 95% CI 1.06-1.20, p=<0.001).

What does this research mean for the field?

In individuals with mild initial COVID-19 illness, female gender and diffuse myocardial involvement on baseline imaging independently predict the presence of persistent cardiac symptoms at long-term follow-up. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 5, 2022Nature Medicine151 citationsOpen Access

Long-term cardiac pathology in individuals with mild initial COVID-19 illness

Q: What are the key findings of this study?

In individuals with mild initial COVID-19 illness, female gender and higher baseline native T1 mapping values independently predicted the presence of persistent cardiac symptoms at follow-up.

Q: What does this research mean for the field?

In individuals with mild initial COVID-19 illness, female gender and diffuse myocardial involvement on baseline imaging independently predict the presence of persistent cardiac symptoms at long-term follow-up. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

VPValentina O. PüntmannCardiac Imaging SMSimon S. MartinGoethe University Frankfurt ASAnastasia ShchendryginaSechenov University

Key Result

In individuals with mild initial COVID-19 illness, female gender and higher baseline native T1 mapping values independently predicted the presence of persistent cardiac symptoms at follow-up.

Study Design

Type

Observational (n=441)

Multicenter

Structured PICO

Does mild initial COVID-19 illness cause long-term inflammatory cardiac involvement and persistent cardiac symptoms in previously healthy individuals?

Population

346 individuals with prior mild COVID-19 infection (non-hospitalized) and no previous cardiac disease or notable comorbidities, mean age 43.3 years, 48% male. A control group of 95 uninfected individuals with no known heart disease or comorbidities was also included.

Intervention

Prior mild COVID-19 infection, assessed via serial cardiac magnetic resonance (CMR) imaging and blood biomarkers at a median of 109 days and 329 days post-infection.

Comparator

Nested case-control comparison with 95 healthy controls with no previous COVID-19 infection and no known heart disease or comorbidities. Internal comparisons were also made between symptomatic and asymptomatic COVID-19 participants.

Outcome

Presence of cardiac symptoms (exertional dyspnea, palpitations, atypical chest pain, syncope) and inflammatory cardiac involvement on CMR (native T1 and T2 mapping, late gadolinium enhancement, pericardial enhancement) at baseline and follow-up.surrogate

Persistent cardiac symptoms following mild COVID-19 illness in previously healthy individuals may be partly explained by ongoing mild inflammatory cardiac involvement detectable on CMR.

Main Result

Effect estimate: OR 1.13 (95% CI 1.06-1.20)

p-value: p=<0.001

Limitations

Single-center cohort study using imaging techniques that are not widely available
Lack of standardization and methodological variations in mapping techniques
No endomyocardial biopsy or Lake Louise criteria deployed
Exploratory study with no a priori sample size estimation
Selection bias due to recruitment by self-referral cannot be excluded
No matching performed for controls

Abstract

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.

Ask AI

Helpful

Bookmark

View Full Paper