78 percent of the study participants at the University Hospital Frankfurt still had heart problems even after a negative corona test. The most frequent long-term damage is myocarditis, as the scientists found out in 60 percent of those who recovered. A team led by cardiologists Eike Nagel and Valentina Puntmann examined a total of 100 patients from the Frankfurt area who had recovered from coronavirus for research purposes – the participants were on average 49 years old.
Of the 100 patients included, 53 (53%) were male and the median (interquartile range [IQR]) age was 49 (45-53) years. The median (IQR) time interval between COVID-19 diagnosis and CMR was 71 (64-92) days. Of the 100 patients who recently recovered from COVID-19, 67 (67%) recovered at home, while 33 (33%) required hospitalization. At the time of CMR, highly sensitive troponin T (hsTnT) was detectable in 71 patients recently recovered from COVID-19 (3 pg/mL or more) and significantly elevated (13.9 pg/mL or more) in 5 patients (5%). Compared to healthy controls and risk factor-adjusted controls, patients recently recovered from COVID-19 had lower left ventricular ejection fraction, higher left ventricular volumes, higher left ventricular mass, and increased native T1 and T2. A total of 78 patients recently recovered from COVID-19 (78%) had abnormal CMR findings, including increased native myocardial T1 (n = 73), increased native myocardial T2 (n = 60), myocardial late gadolinium enhancement (n = 32) and pericardial elevation (n = 22). There was a small but significant difference between patients recovering at home and patients recovering in hospital for native T1 mapping (median [IQR], 1122 [1113-1132] ms vs. 1143 [1131-1156] ms; P = .02) but not for native T2 mapping or hsTnT levels. None of these measures were correlated with time from COVID-19 diagnosis (native T1: r = 0.07; P = .47; native T2: r = 0.14; P = .15; hsTnT: r = -0.07; P = .50). The highly sensitive troponin T was significantly correlated with native T1 mapping (r = 0.35; P < .001) and native T2 mapping (r = 0.22; P = .03). Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation. Native T1 and T2 were the measurements with the best discrimination ability to detect COVID-19-related myocardial pathology.
Even mild progressions damage the heart, 33 of those examined had previously shown severe symptoms. This means that if Covid-19 causes such damage to the heart, we must expect a significant increase in heart failure within a few years,” the scientists said. As with other heart tests, the earlier Covid-19 is diagnosed, the better the chance of stopping the severe inflammatory damage. Cardiologists recommend that people suffering from corona infection should at least be aware of their potentially reduced performance capacity during exercise.
The researchers from Frankfurt know that their study has so far only involved a qualitatively small number of subjects. And as the cardiologists emphasize, they urgently need clinical studies. The researchers also want to continue to monitor the course of heart damage in study participants.
“The global coronavirus disease pandemic of 2019 (COVID-19) continues to cause significant morbidity and mortality worldwide. So far, the focus of the research communication has been on acute respiratory complications, particularly in critically ill patients. A number of case reports and small series indicated that COVID-19 has a prominent effect on the cardiovascular system by exacerbating heart failure in patients with pre-existing heart disease and troponin elevation in critically ill patients. Fatal patients were suspected of having fulminant myocarditis in 7% of patients with fatal outcome. Suggested pathophysiological mechanisms of cardiac injury include inflammatory plaque rupture, stent thrombosis, high cardiac workload and infection via angiotensin-converting enzyme-2 receptors, which cause systemic endothelitis. A small number of autopsy cases indicate infiltration by interstitial mononuclear inflammatory cells, suggesting myocarditis as the underlying mechanism, and some severe cases of myocarditis have been reported. In a small study of recovered patients with persistent cardiac symptoms, cardiovascular magnetic resonance imaging (CMR) showed cardiac involvement consisting of myocardial edema and scarring from late gadolinium enhancement (LGE) in 58% of patients. There remains poor insight into cardiovascular sequelae in unselected patients, including those with no previous diseases, who were not hospitalized or had no or only mild symptoms. In order to better understand the prevalence, extent and nature of cardiovascular sequelae, we proactively examined patients with a documented recent COVID-19 infection using serological markers of cardiac injury and highly standardized depth imaging with CMR”.
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