Cardiac Impairment in Long COVID Predicts Persisting Symptoms

The study covered in this summary was published on MedRxiv.org as a preprint and has not yet been peer-reviewed.

Key Takeaways

Cardiac impairment, imaging-confirmed and usually unrelated to myocarditis, was observed at 6 months in 19% of patients with persistently symptomatic COVID-19; about 60% of those patients showed cardiac impairment at 12 months.
Hospitalization with acute COVID-19 did not predict future cardiac impairment, nor did laboratory cardiac biomarkers or symptoms.
Certain cardiac MRI (CMR) findings at 6 months predicted symptom severity and quality of life at 12 months; they included lower left ventricular ejection fraction (LVEF), low global longitudinal strain (GLS), and elevated myocardial T1.

Why This Matters

There is currently a lack of information on cardiac impairment in patients with long COVID-19.
This study assessed cardiac impairment in patients with long COVID-19 over 12 months, the longest such follow-up to date.

Study Design

The prospective cohort study involved 534 patients with laboratory-confirmed or clinically diagnosed COVID-19 who were assessed at centers in the United Kingdom between May 2020 and August 2021.
They were clinically evaluated and underwent multiorgan MRI; reference ranges were determined from 92 healthy age-matched control subjects.
Quality of life, symptoms, and left ventricular function were assessed using the EQ-5D-5L, Dyspnea-12, and LVD-36 questionnaires.

Key Results

At 6 months after their first symptoms of COVID-19 symptoms, cardiac biomarkers were elevated in six patients (1.1%), of whom only one showed cardiac impairment by CMR.
Such cardiac impairment was evident in 101 patients (19%) among those with normal cardiac biomarker levels.
Cardiac impairment at 6 months primarily consisted of elevated T1 (45%), reduced LVEF (21%), reduced right ventricular ejection fraction (21%), and low GLS (21%).
Most patients with cardiac impairment (81%) had not been hospitalized with COVID-19.
Of those with cardiac impairment, 41% were male, compared with 24% of those without cardiac impairment (P = .001).
Follow-up data were available for 71 of the 102 patients who had cardiac impairment at 6 months. Of those, 42% showed resolution of cardiac impairment at 12 months; such impairment persisted in the remaining 58%.
Ten people with normal cardiac function at 6 months had developed new cardiac impairment at 12 months.
Of those with cardiac impairment at 6 months, 62% reported severe COVID-19 symptoms.
At 12 months, 43% of patients with resolved cardiac impairment and 39% with ongoing cardiac impairment self-reported severe long COVID-19 symptoms.
Low LVEF was associated with persistent cardiac impairment at 12 months (P = .03).
Low GLS at 6 months was associated with poor quality of life at 12 months (odds ratio [OR], 0.78; 95% CI, 0.67 – 0.91; P = .001).
Elevated cardiac T1 on three or more segments at 6 months was associated with lower symptom severity at 12 months (OR, 0.71; 95% CI, 0.52 – 0.96; P = .02).

Limitations

Cardiac impairment was assessed by native T1 mapping to avoid potential complications from gadolinium contrast in patients with COVID-19 renal involvement.
Individuals without cardiac impairment at baseline did not have follow-up scans.
No pre-COVID imaging results were available.
Although COVID-19 disproportionately affects non-White individuals, White individuals accounted for 89% of the included patients.
Further research is needed to identify appropriate therapeutic options for patients with long COVID-19 and cardiac impairment.

Disclosures

This study was funded in part by an Amendment to a European Commission’s Horizon 2020 grant 719445, Non-Invasive Rapid Assessment of Chronic Liver Disease Using Magnetic Resonance Imaging with Liver MultiScan (RADIcAL).
One author received funding from NIHR, AstraZeneca, the European Union, UK Research and Innovation, and British Medical Association. Numerous authors are employees of Perspectum.

This is a summary of a preprint research study, Cardiac Impairment in Long Covid 1-Year Post-SARS-CoV-2 Infection, written by Adriana Roca-Fernández from Perspectum Ltd, Oxford, United Kingdom, and colleagues on MedRxiv.org, provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on MedRxiv.org.

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