Is the heart affected by Coronavirus?
This is looked at by Valentina Puntmann and others in the Journal of American Medical Association Cardiology published July 22, 2020.
They pose the question “What are the cardiovascular effects in unselected patients with recent COVID-19?”.
They looked at 100 patients diagnosed with COVID-19 PCR SARS-CoV-2 positive and imaged them with cardiac MRI. They found that 78% of patients who had recovered from COVID-19 had cardiovascular involvement as detected by standardised cardiac MRI irrespective of pre-existing conditions, the severity and overall course of the COVID-19 presentation, the time from the original diagnosis, or the presence of cardiac symptoms.
The most prevalent abnormality was myocardial inflammation and this was detected in 60%, 60 patients, followed by regional scar and pericardial enhancement. They also found that using classical parameters such as volumes and ejection fractions, these were mildly abnormal. Their findings demonstrated that participants with a relative paucity of pre-existing cardiovascular conditions, with mostly home-based recovery had frequent cardiac inflammatory involvement and that this was similar to the hospitalised subgroup with regards to severity and extent.
Their observations were similar to early case reports of hospitalised patients who showed significant rises in troponin T levels and diffuse inflammatory involvement. However, unlike these previous studies, this study revealed that significant cardiac involvement occurred independently of the severity of original presentation and persisted beyond the period of acute presentation with no significant trend toward reduction of imaging or serological findings during the recovery period.
They suggest that their findings provide an indication of potentially considerable burden of inflammatory disease in a large and growing parts of the population and suggest that this requires confirmation within a larger cohort. Although the long-term health effects of their findings cannot yet be determined, they note that several of the abnormalities described have been previously related to worse outcome in inflammatory cardiomyopathies. Most of the imaging findings point towards ongoing perimyocarditis after COVID-19 infection.
They want to surmise that each of the abnormal imaging parameters can be linked to an underlying pathophysiological process and worse outcome. Clearly their findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19 disease.
Dr Paul Ettlinger
The London General Practice