Heart damage in people recovered from COVID-19
New evidence suggests the coronavirus brings lasting cardiovascular harm.
New evidence suggests the coronavirus has lasting impacts on the heart, raising alarm for cardiologists who have been concerned about potential long-term heart injury from COVID-19.
Two German studies, published Tuesday in the peer-reviewed journal JAMA Cardiology, found heart abnormalities in COVID-19 patients months after they had already recovered from the disease caused by SARS-CoV-2.
The first study included 100 patients from the University of Hospital Frankfurt COVID-19 Registry who were relatively healthy adults in their 40s and 50s. About one-third of the patients required hospitalization, while the rest recovered from home.
Researchers looked at cardiac magnetic resonance imaging taken nearly 21⁄2 months after they were diagnosed and compared them with images from people who never had COVID-19. The study found heart abnormalities in 78 patients, with 60 of those patients showing signs of inflammation in the heart muscle from the virus.
“When this came to our attention, we were struck,” said Dr. Clyde Yancy, chief cardiologist at Northwestern Memorial Hospital and an editor at JAMA Cardiology.
The findings would have been virtually impossible to pinpoint without this study, as the majority of patients didn’t exhibit any symptoms and these specific abnormalities detected by the MRI wouldn’t have been seen on an echocardiogram, which is more commonly used in the standard clinical setting.
Experts say the prevalence of inflammation is an important connection to COVID-19 as the disease has a clinical reputation for a high inflammatory response. Dr. Thomas Maddox, chair of the American College of Cardiology’s Science and Quality Committee, said heart inflammation could lead to weakening of the heart
muscle and, in rare cases, abnormal heart beats.
Yancy said inflammation is the first prerequisite for heart failure and, over a longer period of time, could “leave important residual damage” that could “set up the scenario” for other forms of heart disease.
“We’re not saying that COVID-19 causes heart failure… but it presents early evidence that there’s potentially injury to the heart,” Yancy said.
Maddox says the study contributes to growing evidence to suggest that heart injury in COVID-19 patients may be a “bystander effect” of the overall inflammatory reaction to the virus instead of direct viral invasion of the heart.
Although the inflammation is indicative of COVID-19, Dr. Paul Cremer, a cardiovascular imager at the Cleveland Clinic, says having imaging before patients were sick could have strengthened the study’s argument that the disease could have caused these heart abnormalities.
“Seeing inflammation in the heart muscle… it’s hard to think of other causes because of COVID-19, but I think it needs to be validated in other studies,” he said.
The findings come after a Cleveland Clinic study published July 9 in the medical journal JAMA Network Open spotlighted a number of cases of “broken heart syndrome,” or stress cardiomyopathy, doubled during the COVID-19 pandemic.
Stress cardiomyopathy occurs in response to physical or emotional distress and causes dysfunction or failure in the heart muscle. Experts say more research is needed to understand the implications of these studies and their long-term affect on the heart.
“We need to understand longer term clinical symptoms and outcome that might occur in patients who’ve had it and recovered,” Maddox said. “That will just take some time to look at as more and more people get the infection and recover.”
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