COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors

Abstract: Up to 20-30% of patients hospitalized with coronavirus disease (COVID-19) have evidence of myocardial involvement. Acute cardiac injury in patients hospitalized with COVID-19 is associated with higher morbidity and mortality. There are no data on how acute treatment for COVID-19 may affect convalescent phase or long-term cardiac recovery and function. Myocarditis from other viral pathogens can evolve into overt or subclinical myocardial dysfunction, and sudden death has been described in the convalescent phase of viral myocarditis. This raises concerns for patients recovering from COVID-19. Some patients will have subclinical and possibly overt cardiovascular abnormalities. Patients with ostensibly recovered cardiac function may still be at risk for cardiomyopathy and cardiac arrhythmias. Screening for residual cardiac involvement in the convalescent phase for patients recovered from COVID-19 associated cardiac injury is needed. The type of testing, and therapies for post COVID-19 myocardial dysfunction will need to be determined. Therefore, now is the time to plan for appropriate registries and clinical trials to properly assess these issues and prepare for long-term sequelae of “post-COVID-19 Cardiac Syndrome”

[1]  W. Paulus,et al.  Ventricular myocarditis coincides with atrial myocarditis in patients. , 2014, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[2]  D. Morrow,et al.  COVID-19 for the Cardiologist , 2020, JACC: Basic to Translational Science.

[3]  E. Marbán,et al.  COVID-19 and the Heart , 2020, Circulation research.

[4]  Roberto Maroldi,et al.  Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). , 2020, JAMA cardiology.

[5]  T. West,et al.  Covid-19 in Critically Ill Patients in the Seattle Region — Case Series , 2020, The New England journal of medicine.

[6]  Hongliang Li,et al.  The Science Underlying COVID-19: Implications for the Cardiovascular System. , 2020, Circulation.

[7]  Ke Ma,et al.  Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study , 2020, BMJ.

[8]  R. D. de Boer,et al.  From Inflammation to Fibrosis—Molecular and Cellular Mechanisms of Myocardial Tissue Remodelling and Perspectives on Differential Treatment Opportunities , 2017, Current Heart Failure Reports.

[9]  Eun Ji Kim,et al.  Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. , 2020, JAMA.

[10]  Ting-hui Chen,et al.  Predictors of long-term outcome in patients with biopsy proven inflammatory cardiomyopathy , 2018, Journal of geriatric cardiology : JGC.

[11]  D. Newby,et al.  Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury , 2017, Circulation.

[12]  J. Penninger,et al.  SARS‐coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS , 2009, European journal of clinical investigation.

[13]  Sunil V. Rao,et al.  Management of Acute Myocardial Infarction During the COVID-19 Pandemic , 2020, Journal of the American College of Cardiology.

[14]  Nathaniel Hupert,et al.  Clinical Characteristics of Covid-19 in New York City , 2020, The New England journal of medicine.

[15]  Yi Feng,et al.  The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2 , 2020, Cardiovascular research.

[16]  L. Rosella,et al.  Acute Myocardial Infarction after Laboratory‐Confirmed Influenza Infection , 2018, The New England journal of medicine.

[17]  E. Kogan,et al.  Myocardial Biopsy In "Idiopathic» Atrial Fibrillation And Other Arrhythmias: Nosological Diagnosis, Clinical And Morphological Parallels, And Treatment. , 2016, Journal of atrial fibrillation.

[18]  T. Chao,et al.  The association between influenza infection, vaccination, and atrial fibrillation: A nationwide case-control study. , 2016, Heart rhythm.

[19]  O. Morel,et al.  Ventricular arrhythmias and sudden cardiac arrest in Takotsubo cardiomyopathy: Incidence, predictive factors, and clinical implications. , 2018, Heart rhythm.

[20]  H. Figulla,et al.  Successful use of a wearable cardioverter-defibrillator in myocarditis with normal ejection fraction , 2010, Clinical Research in Cardiology.

[21]  G. Fonarow,et al.  Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality. , 2020, JAMA cardiology.

[22]  Erwan L'Her,et al.  Compassionate Use of Remdesivir for Patients with Severe Covid-19 , 2020, The New England journal of medicine.

[23]  J. Olgin,et al.  Prospective Countywide Surveillance and Autopsy Characterization of Sudden Cardiac Death: POST SCD Study , 2018, Circulation.

[24]  A. Kadish,et al.  Impact of Nontraditional Antiarrhythmic Drugs on Sudden Cardiac Death , 2004 .

[25]  J. Goldberger,et al.  114 – Impact of Nontraditional Antiarrhythmic Drugs on Sudden Cardiac Death , 2018 .

[26]  E. Arbustini,et al.  Myocardial localization of coronavirus in COVID‐19 cardiogenic shock , 2020, European journal of heart failure.

[27]  C. Sardu “ Persistent Long-Term Structural , Functional , and Metabolic Changes After Stress-Induced ( Takotsubo ) Cardiomyopathy ” Circulation , 2018 .

[28]  J. Xiang,et al.  Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study , 2020, The Lancet.

[29]  R. Shephard Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006 , 2010 .

[30]  A. Henning,et al.  Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy , 2017, Circulation.

[31]  Xi Chen,et al.  Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. , 2017, Journal of cardiovascular computed tomography.

[32]  M. Boutjdir,et al.  Autoimmune and inflammatory K+ channelopathies in cardiac arrhythmias: Clinical evidence and molecular mechanisms. , 2019, Heart rhythm.

[33]  H. Huikuri,et al.  Temporal Trends in the Clinical and Pathological Characteristics of Victims of Sudden Cardiac Death in the Absence of Previously Identified Heart Disease , 2016, Circulation. Arrhythmia and electrophysiology.

[34]  E. Romano Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19. , 2021, Arquivos brasileiros de cardiologia.

[35]  Qiurong Ruan,et al.  Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China , 2020, Intensive Care Medicine.

[36]  Xiang Xie,et al.  COVID-19 and the cardiovascular system , 2020, Nature Reviews Cardiology.

[37]  W. Gong,et al.  Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. , 2020, JAMA cardiology.

[38]  G. Barbati,et al.  Long-Term Evolution and Prognostic Stratification of Biopsy-Proven Active Myocarditis , 2013, Circulation.

[39]  Shao‐Wei Chen,et al.  Heart Failure and Mortality of Adult Survivors from Acute Myocarditis Requiring Intensive Care Treatment - A Nationwide Cohort Study , 2017, International journal of medical sciences.

[40]  T. Strabelli,et al.  COVID-19 and the Heart. , 2020, Arquivos brasileiros de cardiologia.

[41]  S. Rizzo,et al.  Ventricular Arrhythmias in Myocarditis: Characterization and Relationships With Myocardial Inflammation. , 2020, Journal of the American College of Cardiology.

[42]  G. Heusch,et al.  Coronary microembolization and microvascular dysfunction. , 2018, International journal of cardiology.

[43]  N. M. Hettiarachchi,et al.  Clinical Characteristics of COVID-19 , 2020, Journal of the Ceylon College of Physicians.

[44]  Binita Shah,et al.  ST-Segment Elevation in Patients with Covid-19 — A Case Series , 2020, The New England journal of medicine.

[45]  B. Maron,et al.  Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006 , 2009, Circulation.

[46]  A. Malavazos,et al.  Targeting the Adipose Tissue in COVID‐19 , 2020, Obesity.

[47]  L. Cooper,et al.  Recognizing COVID-19–related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management , 2020, Heart Rhythm.

[48]  J. Magnani,et al.  Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. , 2006, American heart journal.

[49]  Y. Hu,et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China , 2020, The Lancet.

[50]  M. Packer Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium. , 2018, Journal of the American College of Cardiology.

[51]  Tao Guo,et al.  Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) , 2020, JAMA cardiology.