Cardiovascular symptom phenotypes of post-acute sequelae of SARS-CoV-2

Mahmoud, Zainab; East, Lauren; Gleva, Marye J.; Woodard, Pamela K.; Lavine, Kory J.; Verma, Amanda

doi:10.1016/j.ijcard.2022.07.018

Cited by 16 publications

(24 citation statements)

References 35 publications

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“…Interestingly, the elevated heart rate in our children proceeded with elevated diastolic blood pressure, as recently shown in adults with PASC [ 10 ]. A subclinical diastolic impairment without a systolic involvement may be observed in patients with COVID-19, measured with the myocardial performance index [ 11 ].…”

Section: Discussionsupporting

confidence: 78%

Dysautonomia in Children with Post-Acute Sequelae of Coronavirus 2019 Disease and/or Vaccination

Buchhorn¹

2022

Vaccines

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Long-term health problems such as fatigue, palpitations, syncope, and dizziness are well-known in patients after COVID-19 (post-acute sequelae of coronavirus (PASC)). More recently, comparable problems have been noticed after the SARS-CoV-2 vaccination (post-VAC). The pathophysiology of these problems is not well-understood. Methods: In 38 children and young adults, we tested if these health problems were related to dysautonomia in an active standing test (Group 1: 19 patients after COVID-19; Group 2: 12 patients with a breakthrough infection despite a vaccination; and Group 3: 7 patients after a vaccination without COVID-19). The data were compared with a control group of 47 healthy age-matched patients, as recently published. Results: All patients had a normal left ventricular function as measured by echocardiography. Significantly elevated diastolic blood pressure in all patient groups indicated a regulatory cardiovascular problem. Compared with the healthy control group, the patient groups showed significantly elevated heart rates whilst lying and standing, with significantly higher heart rate increases. The stress index was significantly enhanced in all patient groups whilst lying and standing. Significantly decreased pNN20 values, mostly whilst standing, indicated a lower vagus activity in all patient groups. The respiratory rates were significantly elevated in Groups 1 and 2. Conclusion: The uniform increase in the heart rates and stress indices, together with low pNN20 values, indicated dysautonomia in children with health problems after COVID-19 disease and/or vaccination. A total of 8 patients fulfilled the criteria of postural orthostatic tachycardia syndrome and 9 patients of an inappropriate sinus tachycardia, who were successfully treated with omega-3 fatty acid supplementation and pharmacotherapy.

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Section: Discussionsupporting

confidence: 78%

Dysautonomia in Children with Post-Acute Sequelae of Coronavirus 2019 Disease and/or Vaccination

Buchhorn¹

2022

Vaccines

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Section: Myocardiummentioning

confidence: 99%

“…111,118,119 This post-acute sequelae of COVID-19, also known as long COVID, can occur in patients who experienced only mild cases of acute COVID-19. 2,120 Even more sobering is the discovery that COVID-19 recovered patients, with or without post-acute sequelae of COVID-19, have an increased long-term risk of developing cardiovascular disease and suffering major cardiovascular events. 2,113,121 To date, it is not known whether long COVID-19 and the increased long-term cardiovascular risks following recovery are due to the activation of subclinical cardiac dysfunction sustained in acute COVID-19 illness (as has been detected by strain echocardiography in COVID-19 recovered patients), 122 chronic pathophysiologic signaling within the heart, ongoing or reactivated immune response dysfunction, or irreversible damage incurred during acute illness.…”

Section: Long Covid and The Long-term Cardiovascular Risk Of Post-cov...mentioning

confidence: 99%

Cell-Specific Mechanisms in the Heart of COVID-19 Patients

Tsai

Čiháková

Tucker

2023

Circulation Research

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From the onset of the pandemic, evidence of cardiac involvement in acute COVID-19 abounded. Cardiac presentations ranged from arrhythmias to ischemia, myopericarditis/myocarditis, ventricular dysfunction to acute heart failure, and even cardiogenic shock. Elevated serum cardiac troponin levels were prevalent among hospitalized patients with COVID-19; the higher the magnitude of troponin elevation, the greater the COVID-19 illness severity and in-hospital death risk. Whether these consequences were due to direct SARS-CoV-2 infection of cardiac cells or secondary to inflammatory responses steered early cardiac autopsy studies. SARS-CoV-2 was reportedly detected in endothelial cells, cardiac myocytes, and within the extracellular space. However, findings were inconsistent and different methodologies had their limitations. Initial autopsy reports suggested that SARS-CoV-2 myocarditis was common, setting off studies to find and phenotype inflammatory infiltrates in the heart. Nonetheless, subsequent studies rarely detected myocarditis. Microthrombi, cardiomyocyte necrosis, and inflammatory infiltrates without cardiomyocyte damage were much more common. In vitro and ex vivo experimental platforms have assessed the cellular tropism of SARS-CoV-2 and elucidated mechanisms of viral entry into and replication within cardiac cells. Data point to pericytes as the primary target of SARS-CoV-2 in the heart. Infection of pericytes can account for the observed pericyte and endothelial cell death, innate immune response, and immunothrombosis commonly observed in COVID-19 hearts. These processes are bidirectional and synergistic, rendering a definitive order of events elusive. Single-cell/nucleus analyses of COVID-19 myocardial tissue and isolated cardiac cells have provided granular data about the cellular composition and cell type–specific transcriptomic signatures of COVID-19 and microthrombi-positive COVID-19 hearts. Still, much remains unknown and more in vivo studies are needed. This review seeks to provide an overview of the current understanding of COVID-19 cardiac pathophysiology. Cell type–specific mechanisms and the studies that provided such insights will be highlighted. Given the unprecedented pace of COVID-19 research, more mechanistic details are sure to emerge since the writing of this review. Importantly, our current knowledge offers significant clues about the cardiac pathophysiology of long COVID-19, the increased postrecovery risk of cardiac events, and thus, the future landscape of cardiovascular disease.

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“…A recent retrospective study of a cardiology referral long COVID clinic found among 100 long COVID patients that 19% had a low EF on cardiac MRI and among those, the most common symptoms presenting where chest pain and dyspnea. 13 However, this study could overestimate the prevalence of cardiac disease as it was conducted in a specialty referral clinic. Our study includes consecutive patients in a general long COVID and the prevalence of reduced EF of 11% is likely closer to the true prevalence.…”

Section: Variablesmentioning

confidence: 93%

Cardiovascular risk factors predict who should have echocardiographic evaluation in long COVID

Tamariz,

Ryan,

Marzouka

et al. 2024

Echocardiography

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BackgroundThe need for echocardiograms among patients with long COVID is debatable. Our aim was to evaluate the prevalence of left ventricular (LV) dysfunction and identify predictors.MethodsWe conducted a cross‐sectional study and included all consecutive patients enrolled in our post‐COVID clinic. We included patients who had an echocardiogram and had no previous known heart disease. We defined LV dysfunction as a low ejection fraction or grade II to grade III diastolic dysfunction on an echocardiogram with evidence of elevated filling pressures. We calculated the prevalence of heart disease and predictors of heart disease using logistic regression.ResultsWe included 217 post‐COVID patients enrolled in the clinic. The prevalence of LV dysfunction is 24%; 95% CI 18–30. Predictors of heart disease include older age and a previous history of hypertension and diabetes or having an intermediate or high ASCVD score. Patients with low ASCVD score did not have low ejection fraction on the screening echocardiograms.ConclusionOur study found a considerable number of patients with LV dysfunction. Older patients with cardiovascular risk factors are at risk of long COVID associated heart disease.

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Cardiovascular symptom phenotypes of post-acute sequelae of SARS-CoV-2

Cited by 16 publications

References 35 publications

Dysautonomia in Children with Post-Acute Sequelae of Coronavirus 2019 Disease and/or Vaccination

Dysautonomia in Children with Post-Acute Sequelae of Coronavirus 2019 Disease and/or Vaccination

Cell-Specific Mechanisms in the Heart of COVID-19 Patients

Cardiovascular risk factors predict who should have echocardiographic evaluation in long COVID

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