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Clin Microbiol Infect
. 2021 Jun 22;S1198-743X(21)00335-9.
doi: 10.1016/j.cmi.2021.06.015. Online ahead of print.
Cardiac sequelae after COVID-19 recovery: a systematic review
Mohammad Said Ramadan 1 , Lorenzo Bertolino 1 , Rosa Zampino 2 , Emanuele Durante-Mangoni 3 , Monaldi Hospital Cardiovascular Infection Study Group(∗)
Collaborators, Affiliations
- PMID: 34171458
- DOI: 10.1016/j.cmi.2021.06.015
Abstract
Background: Coronavirus disease 2019 (COVID-19) has been implicated in a wide spectrum of cardiac manifestations following the acute phase of the disease.
Objectives: To assess the range of cardiac sequelae after COVID-19 recovery.
Data sources: PubMed, Embase, Scopus (inception through 17 February 2021), and Google scholar (2019 through 17 February 2021).
Study eligibility criteria: Prospective and retrospective studies, case reports and case series.
Participants: Adult patients assessed for cardiac manifestations after COVID-19 recovery.
Exposure: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosed by polymerase chain reaction (PCR).
Methods: Systematic review.
Results: Thirty-five studies (fifteen prospective cohort, seven case reports, five cross-sectional, four case series, three retrospective cohort and one ambidirectional cohort) evaluating cardiac sequelae in 52609 patients were included. Twenty-nine studies utilized objective cardiac assessments, mostly cardiac magnetic resonance imaging (CMR) in sixteen studies, echocardiography in fifteen, electrocardiography (ECG) in sixteen and cardiac biomarkers in eighteen. Most studies had a fair risk of bias. The median time from diagnosis/recovery to cardiac assessment was 48 days (1-180). Common short-term cardiac abnormalities (<3 months) included increased T1 (proportion: 30%), T2 (16%), pericardial effusion (15%) and late gadolinium enhancement (LGE, 11%) on CMR, with symptoms such as chest pain (25%) and dyspnea (36%). In the medium term (3-6 months), common changes included reduced left ventricular global longitudinal strain (30%) and LGE (10%) on CMR, diastolic dysfunction (40%) on echocardiography and elevated NT-proBNP (18%). In addition, COVID-19 survivors had higher risk (RR = 3; 95% CI: 2.7-3.2) of developing heart failure, arrythmias and myocardial infarction.
Conclusions: COVID-19 appears to be associated with persistent/de novo cardiac injury after recovery, particularly subclinical myocardial injury in the earlier phase and diastolic dysfunction later. Larger well-designed and controlled studies with baseline assessments are needed to better measure the extent of cardiac injury and its clinical impact.
Keywords: CMR; COVID-19; Cardiac effects post COVID-19; Cardiac sequelae; Echocardiography; SARS-CoV-2.