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. 2023 Feb;10(1):e002241.
doi: 10.1136/openhrt-2022-002241.

Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection

Adriana Roca-Fernandez  1 , Malgorzata Wamil  2   3 , Alison Telford  1 , Valentina Carapella  1 , Alessandra Borlotti  1 , David Monteiro  1 , Helena Thomaides-Brears  1 , Matt Kelly  1 , Andrea Dennis  1 , Rajarshi Banerjee  1 , Matthew Robson  1 , Michael Brady  1 , Gregory Y H Lip  4 , Sacha Bull  5 , Melissa Heightman  6 , Ntobeko Ntusi  7 , Amitava Banerjee  8   9   10
Affiliations

Cardiac abnormalities in Long COVID 1-year post-SARS-CoV-2 infection

Adriana Roca-Fernandez et al. Open Heart. 2023 Feb.

Abstract

Background: Long COVID is associated with multiple symptoms and impairment in multiple organs. Cross-sectional studies have reported cardiac impairment to varying degrees by varying methodologies. Using cardiac MR (CMR), we investigated a 12-month trajectory of abnormalities in Long COVID.

Objectives: To investigate cardiac abnormalities 1-year post-SARS-CoV-2 infection.

Methods: 534 individuals with Long COVID underwent CMR (T1/T2 mapping, cardiac mass, volumes, function and strain) and multiorgan MRI at 6 months (IQR 4.3-7.3) since first post-COVID-19 symptoms. 330 were rescanned at 12.6 (IQR 11.4-14.2) months if abnormal baseline findings were reported. Symptoms, questionnaires and blood samples were collected at both time points. CMR abnormalities were defined as â‰Ĩ1 of low left or right ventricular ejection fraction (LVEF), high left or right ventricular end diastolic volume, low 3D left ventricular global longitudinal strain (GLS), or elevated native T1 in â‰Ĩ3 cardiac segments. Significant change over time was reported by comparison with 92 healthy controls.

Results: Technical success of multiorgan and CMR assessment in non-acute settings was 99.1% and 99.6% at baseline, and 98.3% and 98.8% at follow-up. Of individuals with Long COVID, 102/534 (19%) had CMR abnormalities at baseline; 71/102 had complete paired data at 12 months. Of those, 58% presented with ongoing CMR abnormalities at 12 months. High sensitivity cardiac troponin I and B-type natriuretic peptide were not predictive of CMR findings, symptoms or clinical outcomes. At baseline, low LVEF was associated with persistent CMR abnormality, abnormal GLS associated with low quality of life and abnormal T1 in at least three segments was associated with better clinical outcomes at 12 months.

Conclusion: CMR abnormalities (left entricular or right ventricular dysfunction/dilatation and/or abnormal T1mapping), occurred in one in five individuals with Long COVID at 6 months, persisting in over half of those at 12 months. Cardiac-related blood biomarkers could not identify CMR abnormalities in Long COVID.

Trial registration number: NCT04369807.

Keywords: COVID-19; EPIDEMIOLOGY; Magnetic Resonance Imaging; Myocarditis.

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Conflict of interest statement

Competing interests: AD, AT, VC, ABo, SF, MP, ARF, HTB, MK, MR, MB and RB are employees of Perspectum.

Figures

Figure 1
Figure 1
Study population for cardiac complications of long COVID. *Individuals were eligible for follow up when MRI abnormality or abnormal bloods in any organ were found at baseline.
Figure 2
Figure 2
Central illustration. Evolution and characteristics of cardiac abnormalities in Long Covid 1-year post-SARS-CoV-2 infection. Numbers in the table are referring to number of patients. *Referring to high sensitivity cardiac troponin I and B-type natriuretic peptide. CRP, C reactive protein; EQ-5D-5L, EuroQoL-5 dimension-5 level; LVEF, left ventricular ejection fraction.
See this image and copyright information in PMC

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