Prevalence of cardiac dysfunction and symptoms in long COVID

Background Persistent symptoms following SARS-CoV-2 infection are frequently reported. It remains unclear whether these symptoms are associated with cardiac structure, function, and pulmonary congestion at long-term follow-up. Purpose To determine the prevalence of cardiac dysfunction and pulmonary congestion at long-term follow-up in individuals with long COVID and compare findings between individuals with long COVID and individuals previously infected with SARS-CoV-2 without persistent symptoms. Methods Adults with prior laboratory-confirmed SARS-CoV-2 infection across different acute disease severity levels (home-managed, hospitalized, ICU-treated) underwent follow-up approximately 4 years after infection, including transthoracic echocardiography and 8-zone lung ultrasound. Long COVID was defined according to WHO criteria as ≥1 symptom persisting ≥3 months after infection and lasting >2 months without alternative explanation. Echocardiography assessed left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diastolic indices, right ventricular function, and left atrial strain. Lung ultrasound findings were quantified by total B-lines and the presence of ≥3 B-lines. Continuous and categorical variables were compared using appropriate parametric or non-parametric tests. Results Among 696 participants included with prior acute COVID-19 (median age 62 years, 50% male), 233 (33%) fulfilled the criteria for long COVID. Overall, 93% were vaccinated for COVID-19, with vaccination rates of 90% in the long COVID group and 95% in those without long COVID (p=0.043). Individuals with long COVID more frequently required hospitalization (38% vs 18%) or ICU admission (12% vs 4%; both p<0.001) during acute infection. Dyspnea and functional limitation were common in long COVID. NYHA ≥ II was present in 71% compared with 39% in individuals with vs. without long COVID (p<0.001). Fatigue assessed by the Fatigue Assessment Scale (FAS) was higher (21 vs 17, p<0.001), and health-related quality of life measured by the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) was lower (0.86 vs 0.94, p<0.001) in individuals with vs. without long COVID (Figure 1). Individuals with long COVID had higher BMI (29.0 vs 26.5 kg/m², p<0.001), higher resting heart rate (p<0.001), and higher hsCRP levels (1.55 vs 1.10 mg/L, p=0.001). Echocardiographic measures in individuals with long COVID were 54.3 ± 11.5% for LVEF, 19.6 ± 3.7% for GLS, 7.5 (6.3-9.5) for E/e′, and 2.10 (1.90-2.40) cm for TAPSE. These values did not differ significantly from individuals without long COVID. In patients with long COVID, ≥3 B-lines were present in 13.1% vs. 9.3% in no long COVID (p=0.14) (Figure 2). Conclusion Long COVID was characterized by persistent symptoms at long-term follow-up, including dyspnea and reduced health status. However, no obvious differences in cardiac structure and function were found between patients with and without long COVID.