In Norway, COVID survivors did not show progressive changes in cardiac structure and function that would explain persistent symptoms months later, a cohort study showed.
From 3 to 12 months after hospitalization, echocardiography in 182 patients did not reveal significant global changes in any left ventricular (LV) measurements or right ventricular structure and function. This was despite more than half of the patients reporting dyspnoea at 3 months, which largely persisted for 12 months.
The most frequent pathologies on echocardiography were:
- Low overall LV longitudinal strain (19% at 3 months and 15% at 12 months, P=0.44)
- Low LV ejection fraction (16% and 14%, P=0.44)
- Diastolic dysfunction (13% and 17%, P=0.17)
Cardiac structure and function were unrelated to shortness of breath. Furthermore, there was no significant change in arrhythmia burden between 3 and 12 months, reported Charlotte Ingul, MD, PhD, of the Norwegian University of Science and Technology in Trondheim, and colleagues in the PROLUN group. His manuscript was published in Clinical Cardiology🇧🇷
“Although we did not have pre-COVID echocardiographic data from participants, these findings suggest that there is limited long-term cardiac remodeling and progressive dysfunction after hospitalization for COVID-19, and that cardiac recovery from acute illness predominantly occurs in the first 3 months,” wrote the authors.
Previous studies have reported cardiac dysfunction in the acute phase of COVID illness. However, the long-term significance of a finding such as diffuse fibrosis, myocardial edema or myocardial scarring is unclear.
Even so, cardiac involvement long after SARS-CoV-2 infection is supported by the National COVID Cohort Collaborative’s finding that the incidence of heart failure (HF) increased by 45% after hospitalization for COVID.
One author of that study, HF specialist Marat Fudim, MD, MHS, of the Duke Clinical Research Institute in Durham, NC, said he suspects this is caused by HF that is likely induced by a general deterioration in cardiovascular and pulmonary status and becomes apparent months to years later.
“How to frame a relatively benign cardiac echocardiogram trend in the Norwegian study and repeat studies showing high incidence of HF is that COVID is a multisystem disease and I suspect most of the damage is caused outside the heart,” said Fudim medpage today🇧🇷
“Insults to the autonomic, pulmonary, and vascular systems likely lead to what we think of as long COVID. The heart may be more or less unharmed in these cases, but patients experience dyspnea, fatigue, dizziness, palpitations, and tachycardia,” he said. “Whether these cases can all be classified as IC or not, I don’t know.”
PROLUN was a prospective observational study conducted in six large hospitals in Norway. Participants were people hospitalized with COVID-19 from February to June 2020.
Included in this analysis were those who underwent an echocardiogram 3 and 12 months after hospital discharge. Due to limited capacity, 24-hour ECG monitoring over 12 months has been limited to people who have had an arrhythmia within 3 months.
The study cohort averaged 58 years old and 59% were men. The average BMI was 28.2. One in five has been hospitalized with severe COVID-19 illness.
Ingul’s group recognized that the observational study was subject to several biases. Furthermore, the data were collected in the early days of the pandemic, when current SARS-CoV-2 variants were not yet in circulation.
Fudim had no disclosures.