Cardiopulmonary long-term effects 30 months after severe COVID-19 infection

AIMS: The aim of this study was to assess symptoms and long-term cardiopulmonary impairments over a period of up to 30 months following severe COVID-19 infection. METHODS AND RESULTS: This prospective multicenter cohort study included 200 patients hospitalized between February 2020 and October 2021 with a PCR-confirmed COVID-19 infection. Follow-up examinations 6, 18, and 30 months post-discharge included electrocardiogram, transthoracic echocardiography, cardiac magnetic resonance imaging, chest computed tomography (CT) scan, pulmonary function test (PFT), 6-min walk test, and a laboratory panel. 200 patients completed their 6-month follow-up after discharge and those with pathological findings on cardiopulmonary imaging received additional follow-ups at 18 and 30 months (170 and 139 patients, respectively).At 30 months, most of the cardiopulmonary imaging abnormalities had resolved. Only two patients with previously reduced left ventricular function had persistent mild impairment at 30 months [6 months: n = 15 (8%)]. Pericardial effusion resolved in all patients but one [6 months: n = 28 (17%)]. Signs of pericarditis and myocarditis had already regressed at the 18-month follow-up [6 months: n = 7 (5%)].Chest CT scans showed partial improvement: only one patient had complete resolution at 30 months, while the remaining patients [30 months: n = 17 (94%)] developed minor fibrotic and scarred tissue [6 months: n = 41 (24%)].Long COVID incidence was high with 73% at 6 months and still 49% at 30 months, with no clear predictors identified. CONCLUSION: Even though cardiopulmonary functional and structural abnormalities regressed over time, almost half of the patients still suffered from Long COVID at 30 months. The disconnect between pathological cardiopulmonary findings and reported symptoms, continues to pose a persistent clinical challenge in the understanding and managing Long COVID.