tetano
Editor, Senior Moderator
Nat Commun
. 2026 Jul 30;17(1):7599.
doi: 10.1038/s41467-026-75991-w.
Losartan and prednisolone for post-COVID syndrome and cardiac inflammation: a randomized, double-blind, placebo-controlled trial
Valentina O Puntmann[SUP] #[/SUP][SUP] 1 2 [/SUP], Eike Nagel[SUP] #[/SUP][SUP] 3 4 5 [/SUP], Dietrich Beitzke[SUP] 6 [/SUP], Andreas Kammerlander[SUP] 7 [/SUP], Inga Voges[SUP] 8 [/SUP], Marcus Doerr[SUP] 9 [/SUP], Bishwas Chamling[SUP] 9 [/SUP], Biykem Bozkurt[SUP] 10 [/SUP], Juan Carlos Kaski[SUP] 11 [/SUP], Erica Spatz[SUP] 12 [/SUP], Eva Herrmann[SUP] 13 [/SUP], Gernot Rohde[SUP] 14 [/SUP], Philipp DeLeuw[SUP] 15 [/SUP], Christine Windemuth-Kieselbach[SUP] 16 [/SUP], Sebastian Eckhardt[SUP] 16 [/SUP], Peter C Taylor[SUP] 17 [/SUP], Colin Berry[SUP] 18 [/SUP]
Affiliations
Persistent cardiac symptoms are common in post-COVID syndrome, even without structural heart disease. Evidence implicates immune dysregulation, endothelial dysfunction and low-grade cardiovascular inflammation. Yet no targeted treatment exists. Myoflame-19 is a multicenter, double-blind clinical trial of 279 participants with inflammatory cardiac involvement defined by cardiovascular magnetic resonance, randomized 1:1 to losartan plus prednisolone (n = 139) or matching placebos (n = 140) for 16 weeks. The modified intention-to-treat population comprised 124 and 122 participants. The primary endpoint, change in left ventricular (LV) ejection fraction, was neutral: between-group difference 0.74 percentage points (pp), 95%CI -0.14 to 1.62, p = 0.10, unpaired t-test; supportive baseline-adjusted ANCOVA 0.99, 95%CI 0.15-1.83, p = 0.021. Among prespecified secondary endpoints, several symptom and imaging measures showed numerical differences favoring intervention, including Average Symptom Score components (modified Canadian Chest Pain Scale -4.8 pp, 95%CI -17.3 to 7.6; NYHA class -8.1 pp, -20.6 to 4.3; Long COVID symptom burden -7.7 pp, -18.9 to 3.6), native T1 and T2 values (native T1 -2.46 ms, -8.35 to 3.42; native T2 -0.31 ms, -1.16 to 0.53), and LV end-diastolic volume ( + 1.45 ml/m², -0.09 to 3.00); however, confidence intervals included the null value and these findings should be regarded as hypothesis-generating.Treatment was safe and well-tolerated. These findings indicate a neutral treatment effect on the primary endpoint. They inform targeted immunomodulation and design of future trials in post-COVID syndrome and inflammatory cardiac involvement. Trial registration: EudraCT 2022-001682-12; NCT05619653.
. 2026 Jul 30;17(1):7599.
doi: 10.1038/s41467-026-75991-w.
Losartan and prednisolone for post-COVID syndrome and cardiac inflammation: a randomized, double-blind, placebo-controlled trial
Valentina O Puntmann[SUP] #[/SUP][SUP] 1 2 [/SUP], Eike Nagel[SUP] #[/SUP][SUP] 3 4 5 [/SUP], Dietrich Beitzke[SUP] 6 [/SUP], Andreas Kammerlander[SUP] 7 [/SUP], Inga Voges[SUP] 8 [/SUP], Marcus Doerr[SUP] 9 [/SUP], Bishwas Chamling[SUP] 9 [/SUP], Biykem Bozkurt[SUP] 10 [/SUP], Juan Carlos Kaski[SUP] 11 [/SUP], Erica Spatz[SUP] 12 [/SUP], Eva Herrmann[SUP] 13 [/SUP], Gernot Rohde[SUP] 14 [/SUP], Philipp DeLeuw[SUP] 15 [/SUP], Christine Windemuth-Kieselbach[SUP] 16 [/SUP], Sebastian Eckhardt[SUP] 16 [/SUP], Peter C Taylor[SUP] 17 [/SUP], Colin Berry[SUP] 18 [/SUP]
Affiliations
- PMID: 42533000
- PMCID: PMC13424660
- DOI: 10.1038/s41467-026-75991-w
Persistent cardiac symptoms are common in post-COVID syndrome, even without structural heart disease. Evidence implicates immune dysregulation, endothelial dysfunction and low-grade cardiovascular inflammation. Yet no targeted treatment exists. Myoflame-19 is a multicenter, double-blind clinical trial of 279 participants with inflammatory cardiac involvement defined by cardiovascular magnetic resonance, randomized 1:1 to losartan plus prednisolone (n = 139) or matching placebos (n = 140) for 16 weeks. The modified intention-to-treat population comprised 124 and 122 participants. The primary endpoint, change in left ventricular (LV) ejection fraction, was neutral: between-group difference 0.74 percentage points (pp), 95%CI -0.14 to 1.62, p = 0.10, unpaired t-test; supportive baseline-adjusted ANCOVA 0.99, 95%CI 0.15-1.83, p = 0.021. Among prespecified secondary endpoints, several symptom and imaging measures showed numerical differences favoring intervention, including Average Symptom Score components (modified Canadian Chest Pain Scale -4.8 pp, 95%CI -17.3 to 7.6; NYHA class -8.1 pp, -20.6 to 4.3; Long COVID symptom burden -7.7 pp, -18.9 to 3.6), native T1 and T2 values (native T1 -2.46 ms, -8.35 to 3.42; native T2 -0.31 ms, -1.16 to 0.53), and LV end-diastolic volume ( + 1.45 ml/m², -0.09 to 3.00); however, confidence intervals included the null value and these findings should be regarded as hypothesis-generating.Treatment was safe and well-tolerated. These findings indicate a neutral treatment effect on the primary endpoint. They inform targeted immunomodulation and design of future trials in post-COVID syndrome and inflammatory cardiac involvement. Trial registration: EudraCT 2022-001682-12; NCT05619653.