Frankfurt study finds high rate of cardiac complications in recovered COVID-19 patients

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A German study of recently-recovered COVID-19 patients examined using magnetic resonance imaging (MRI) revealed cardiac involvement in 78% of patients, and ongoing myocardial inflammation in 60%. Published online in JAMA: Cardiology, the study’s findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19, according to lead author Valentina Puntmann (University Hospital Frankfurt, Frankfurt, Germany) and colleagues.

Puntmann and colleagues identified 100 patients recently recovered from COVID-19 through the University Hospital Frankfurt Registry between April and June 2020. Patients were considered eligible after a minimum of two weeks from the original diagnosis if they had resolution of respiratory symptoms and negative results on a swab test at the end of the isolation period. Sixty-seven  patients recovered at home, while 33 required hospitalisation.

Comparisons were made with age-matched and sex-matched control groups of healthy volunteers (n=50) and risk factor matched patients (n=57). The study team found that a total of 78 patients who had recovered from COVID-19 infection had cardiovascular involvement as detected by standardised cardiovascular magnetic resonance imaging, irrespective of pre-existing conditions, the severity and overall course of the COVID-19 presentation, the time from the original diagnosis, or the presence of cardiac symptoms.

The most prevalent abnormality was myocardial inflammation (defined as abnormal native T1 and T2 measures), detected in 60 patients recently recovered from COVID-19 (60%), followed by regional scar and pericardial enhancement.

Discussing the significance of the findings, the study team wrote: “To our knowledge, this is the first prospective report on a cohort of unselected patients with a recent COVID-19 infection identified from a local testing centre who voluntarily underwent evaluation for cardiac involvement with CMR [cardiovascular magnetic resonance imaging].

“The results of our study provide important insights into the prevalence of cardiovascular involvement in the early convalescent stage. Our findings demonstrate that participants with a relative paucity of pre-existing cardiovascular condition and with mostly home-based recovery had frequent cardiac inflammatory involvement, which was similar to the hospitalised subgroup with regards to severity and extent.”

In an editorial published alongside the JAMA: Cardiology article, by the publication’s deputy editor Clyde Yancy (Northwestern University Feinberg School of Medicine, Chicago, USA) and section editor Gregg Fonarow (University of California, Los Angeles, USA), the authors said that the findings of the Frankfurt study “could not be dismissed”.

“Months after a COVID-19 diagnosis, the possibility exists of residual left ventricular dysfunction and ongoing inflammation, both of sufficient concern to represent a nidus for new-onset heart failure and other cardiovascular complications,” Yancy and Fonarow write. They add that further investigation is needed to “carefully examine existing and prospectively collect new data in other populations to confirm or refute the findings”.

“Given the pressing burden of the ongoing COVID-19 crisis, as well as the initiation of longitudinal care models for those recovering from COVID-19, the concerns we are raising are not theoretical but instead practical and require our due diligence to study and prepare for what may be another dimension of the COVID-19 crisis,” Yancy and Fonarow conclude.


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