Cardiovascular sequalae in uncomplicated COVID-19 survivors

Abstract

Background A high proportion of COVID-19 patients were reported to have cardiac involvements. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance. Methods We performed a systematic cardiac screening for 97 consecutive COVID-19 survivors including electrocardiogram (ECG), echocardiography, serum troponin and NT-proBNP assay 1–4 weeks after hospital discharge. Treadmill exercise test and cardiac magnetic resonance imaging (CMR) were performed according to initial screening results. Results The mean age was 46.5 ± 18.6 years; 53.6% were men. All were classified with non-severe disease without overt cardiac manifestations and did not require intensive care. Median hospitalization stay was 17 days and median duration from discharge to screening was 11 days. Cardiac abnormalities were detected in 42.3% including sinus bradycardia (29.9%), newly detected T-wave abnormality (8.2%), elevated troponin level (6.2%), newly detected atrial fibrillation (1.0%), and newly detected left ventricular systolic dysfunction with elevated NT-proBNP level (1.0%). Significant sinus bradycardia with heart rate below 50 bpm was detected in 7.2% COVID-19 survivors, which appeared to be self-limiting and recovered over time. For COVID-19 survivors with persistent elevation of troponin level after discharge or newly detected T wave abnormality, echocardiography and CMR did not reveal any evidence of infarct, myocarditis, or left ventricular systolic dysfunction. Conclusion Cardiac abnormality is common amongst COVID-survivors with mild disease, which is mostly self-limiting. Nonetheless, cardiac surveillance in form of ECG and/or serum biomarkers may be advisable to detect more severe cardiac involvement including atrial fibrillation and left ventricular dysfunction.

Implementation of a practice plan for the outpatient cardiac evaluation of children after acute SARS-CoV-2 infection and a report of outcomes

“…However, this finding is consistent with other studies that have noticed elevated rates of sinus bradycardia in adults following SARS-CoV-2 infection. 9 These findings are similar to the experience seen in patients with SARS in 2003, in which sinus bradycardia was commonly seen and typically resolved after 2-3 weeks. 10 …”

COVID‐19 induced bradyarrhythmia and relative bradycardia: An overview

“…Sinus bradycardia was present in 29.9% of patients, atrial fibrillation 1.0%, and bradycardia with a heart rate of less than 50 beats per minute in 7.2% of patients 18 . Additionally, 6.2% of patients were found to have troponins elevated above baseline, however, echocardiography or cardiac magnetic resonance imaging after discharge revealed no acute findings 18 . Similarly, Chen et al reviewed the extent of cardiovascular involvement in 54 patients with significant COVID‐19‐related complications 19 .…”

“…Zhou et al presented a report of 97 previously admitted COVID‐19 survivors of which cardiac abnormalities were found in 42.3% of patients 18 . Sinus bradycardia was present in 29.9% of patients, atrial fibrillation 1.0%, and bradycardia with a heart rate of less than 50 beats per minute in 7.2% of patients 18 .…”

“…Zhou et al presented a report of 97 previously admitted COVID‐19 survivors of which cardiac abnormalities were found in 42.3% of patients 18 . Sinus bradycardia was present in 29.9% of patients, atrial fibrillation 1.0%, and bradycardia with a heart rate of less than 50 beats per minute in 7.2% of patients 18 . Additionally, 6.2% of patients were found to have troponins elevated above baseline, however, echocardiography or cardiac magnetic resonance imaging after discharge revealed no acute findings 18 .…”

Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID‐19: A systematic review

“…Echocardiographic follow up after acute COVID-19 LV and RV dysfunction, whether it is clinical or subclinical resolves in most patients post resolution of acute COVID-19. 44,50,57,85 In a study by Churchill et al, a follow up ECHO was done in 11 patients after a median of 14 days post-acute COVID-19. The resolution of previously noted LV dysfunction and/or WMA was ascertained in 9/11 patients.…”