Beyond acute infection: molecular mechanisms underpinning cardiovascular complications in long COVID

Mostafa, Roba Hamed; Moustafa, Ahmed

doi:10.3389/fcvm.2024.1268571

Cited by 3 publications

(1 citation statement)

References 115 publications

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“…Beyond the immune system, LC affects most organs and organ systems in the body, including the heart [3][4][5], lungs, brain [6][7][8][9][10], kidneys [11][12][13], liver, and gut in general [14][15][16], including the spleen, pancreas [17][18][19][20][21][22], and also the reproductive system [23,24]. Resulting symptoms include chronic fatigue, shortness of breath, postural orthostatic tachycardia syndrome (POTS), palpitations, myalgias, arthralgias, cognitive impairment, headaches, sleep disturbances, secondary anxiety, depression, nausea, and diarrhea.…”

Section: Introductionmentioning

confidence: 99%

Long COVID: Long-Term Impact of SARS-CoV2

Makhluf,

Madany,

Kim

2024

Diagnostics

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Four years post-pandemic, SARS-CoV-2 continues to affect many lives across the globe. An estimated 65 million people suffer from long COVID, a term used to encapsulate the post-acute sequelae of SARS-CoV-2 infections that affect multiple organ systems. Known symptoms include chronic fatigue syndrome, brain fog, cardiovascular issues, autoimmunity, dysautonomia, and clotting due to inflammation. Herein, we review long COVID symptoms, the proposed theories behind the pathology, diagnostics, treatments, and the clinical trials underway to explore treatments for viral persistence, autonomic and cognitive dysfunctions, sleep disturbances, fatigue, and exercise intolerance.

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Section: Introductionmentioning

confidence: 99%

Long COVID: Long-Term Impact of SARS-CoV2

Makhluf,

Madany,

Kim

2024

Diagnostics

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Long-Term Coronary Microvascular and Cardiac Dysfunction Following Severe COVID-19 Hospitalization

Johansson,

Loewenstein,

Lodin

et al. 2024

Preprint

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Background: Coronavirus disease 2019 (COVID-19) can lead to long-term cardiopulmonary symptoms and is associated to coronary microvascular dysfunction (CMD). However, long-term data on CMD following severe COVID-19 are lacking. Objective: To determine long-term left ventricular (LV) function and presence of CMD after severe COVID-19, utilizing cardiovascular magnetic resonance (CMR) and stress perfusion mapping. Methods: Hospitalized COVID-19 patients underwent CMR at 10 months follow-up (1.5T Aera, Siemens Healthineers) including cine imaging, native T1 and T2, extracellular volume, and adenosine stress perfusion mapping. Clinical data were obtained from patient records. Patients were compared to volunteers without symptomatic ischemic heart disease (IHD). Results: COVID-19 patients (n=37, age 56±12 years, 76% male) and volunteers (n=22, age 51±13 years, 55% male, p=ns for both) were included. COVID-19 patients demonstrated reduced stress perfusion (2.8±0.81 vs 3.4±0.69 ml/min/g, p=0.003), impaired global longitudinal strain (GLS, -17±2 vs -19±2 %, p=0.003) and global circumferential strain (GCS, -16±3 vs -19±3 %, p=0.001). There were no differences in stress perfusion or myocardial perfusion reserve between COVID-19 patients with or without cardiovascular risk factors or cardiac symptoms. Conclusion: COVID-19 patients exhibit long-term reduced stress perfusion indicating CMD, and impaired LV function by GLS and GCS. Lack of variation in stress perfusion between patients with and without cardiovascular risk factors suggests that CMD may be a consequence of severe COVID-19, warranting further investigation to elucidate mechanisms, and guide potential therapeutic interventions.

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The negative effects of long COVID-19 on cardiovascular health and implications for the presurgical examination

Stimart,

Hipkins

2024

Journal of Osteopathic Medicine

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Context In 2019, emergence of the novel and communicable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection took scientific communities by surprise and imposed significant burden on healthcare systems globally. Although the advent of this disease piqued the interest of academic centers, healthcare systems, and the general public, there is still much yet to be elucidated regarding epidemiology, pathophysiology, and long-term impacts of coronavirus disease 2019 (COVID-19). It has been established that long COVID-19 can impact multiple organ systems, including the cardiovascular system, unfavorably. Although the pathophysiology of this damage is not well understood, adverse sequelae may range from chest pain and arrhythmias to heart failure (HF), myocardial infarction, or sudden cardiac death. For any postacute COVID-19 patient requiring a surgical procedure, the potential for cardiac injury secondary to long COVID-19 must be considered in the preoperative cardiac examination. Objectives This literature review serves to add to the growing body of literature exploring postacute cardiovascular outcomes of COVID-19, with a focus on presurgical cardiac clearance in the adult patient. Specifically, this review studies the prevalence of cardiovascular symptomatology including chest pain, arrhythmias, blood pressure changes, myo-/pericarditis, HF, cardiomyopathy, orthostatic intolerance, and thromboembolism. Although current evidence is scarce in both quality and quantity, it is the goal that this review will highlight the negative impacts of long COVID-19 on cardiovascular health and encourage providers to be cognizant of potential sequelae in the context of the presurgical examination. Methods For this study, peer-reviewed and journal-published articles were selected based on established inclusion and exclusion criteria to address the question “How does long COVID-19 impact the presurgical cardiac examination of an adult scheduled to undergo a noncardiac procedure?” Inclusion criteria included human studies conducted in adult patients and published in peer-reviewed journals up until May 2024 examining the effects of long-COVID-19 infection on the cardiovascular system. Exclusion criteria eliminated unpublished reports, preprints, duplicate articles, literature regarding coronavirus strains other than COVID-19, studies regarding post-COVID-19 vaccination complications, animal studies, and studies conducted in people younger than 18 years of age. A total of 6,675 studies were retrieved from PubMed and Google Scholar. Following screening, 60 studies were included in final consideration. Results Cardiovascular symptoms of postacute COVID-19 infection were encountered with the following percentages prevalence (total numbers of articles mentioning symptom/total number of articles [60]): chest pain (83.3), arrhythmias (88.3), hypertension (40.0), hypotension (16.7), myocarditis (80.0), pericarditis (51.7), HF (70.0), cardiomyopathy (55.0), orthostatic intolerance (56.7), and thromboembolic events (85.0). Conclusions The presence of persisting COVID symptoms may negatively impact the patient’s physical examination, blood tests, electrocardiogram (ECG), imaging, and/or echocardiogram. Cardiac conditions associated with long COVID require special attention in the context of the presurgical candidate due to an increased risk of sudden cardiac death, myocarditis, stroke, and myocardial infarction – even in those who were healthy prior to acute COVID-19 infection. Until more specific scientific evidence comes to light, care of these patients should be viewed through the prism of the best practices already in use and clinicians should maintain a low threshold to pursue more extensive cardiac workup prior to surgery.

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Beyond acute infection: molecular mechanisms underpinning cardiovascular complications in long COVID

Cited by 3 publications

References 115 publications

Long COVID: Long-Term Impact of SARS-CoV2

Long COVID: Long-Term Impact of SARS-CoV2

Long-Term Coronary Microvascular and Cardiac Dysfunction Following Severe COVID-19 Hospitalization

The negative effects of long COVID-19 on cardiovascular health and implications for the presurgical examination

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