No long-term cardiac damage after mild COVID-19 infection, reassures JACC study

There has been some speculation about long-term effects of COVID-19 infection on heart. Some initial studies (1, 2) suggested a long-term sequelae of chronic myocarditis in COVID survivors prompting a need for regular screening even after mild or asymptomatic infections. The study designs and statistical methods of these studies have often been challenged and now Joy et al have refuted such claims of a "chronic myocarditis" in post-COVID phase among health care workers who suffered mild infections. There were absolutely no differences in biomarkers of heart function or heart scans using echocardiography or magnetic resonance. The study was published in JACC Cardiovascular Imaging.

Studies reporting long-term cardiac damage post COVID-19 has led to avoidance of college sports among young atheletes. The news coverage and social media posts of these studies has continued at a frenzied pace. And people with mild or even asymptomatic disease sought out cardiac magnetic resonance scans, and some physicians even recommended having them. But most of these studies had flaws in study designs, lack of control group and small sample sizes.

Joy et al in a well designed study aimed to determine the prevalence and extent of late cardiac and cardiovascular sequelae after mild nonhospitalized SARS-CoV-2 infection.

Participants were recruited from COVIDsortium, a 3-hospital prospective study of 731 health care workers who underwent first-wave weekly symptom, polymerase chain reaction, and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post-infection, 74 seropositive and 75 age-, sex-, and ethnicity-matched seronegative control subjects were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated cardiovascular magnetic resonance and blood biomarkers).

Among the 149 subjects recruited, there were no differences in cardiac structure (left ventricular volumes, mass, atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T1, T2, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro–B-type natriuretic peptide) between the seronegative and seropositive groups.

This study demonstrates that in healthy people, measured cardiovascular abnormalities are common, but no more common in those who had had mild SARS-CoV-2 6 months previously compared with those who had not. In other words, in this population, mild COVID-19 left no measurable cardiovascular impact on LV structure, function, scar burden, aortic stiffness, or serum biomarkers.

The cardiovascular phenotyping employed was comprehensive and measured parameters that reflected cardiac structure (LV volumes, mass, LA area), function (LVEF, global longitudinal shortening, mitral annular plane systolic excursion), inflammation (T1 and T2), focal fibrosis (LGE), diffuse fibrosis (ECV), aortic compliance, heart rate, blood pressure, and high-sensitivity troponin and NT-proBNP.

The current study has a number of advantages and was designed to address the knowledge gaps arising from prior studies:

1. As a nested substudy of COVIDsortium, participants were prospectively recruited predominantly prior to infection, hence minimizing recruitment bias.

2. Control subjects were recruited from the same study contemporaneously, and were well matched with cases.

Published the same week, the latest in a series of analyses looking at college athletes who recovered from mild COVID also found no evidence of cardiac damage on imaging.(3)

"Our study provides societal reassurance for the cardiovascular health of working-age individuals with convalescence from mild SARS-CoV-2. Screening asymptomatic individuals following mild diseases is not indicated", concluded the authors.

Source: JACC Cardiovascular Imaging: Joy G, Artico J, Kurdi H, et al. Prospective case-control study of cardiovascular abnormalities 6 months following mild COVID-19 in healthcare workers. J Am Coll Cardiol Img. 2021

References:

1. Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(11):1265–1273. doi:10.1001/jamacardio.2020.3557

2. Rajpal S, Tong MS, Borchers J, et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiol. 2021;6(1):116–118. doi:10.1001/jamacardio.2020.4916

3. Hendrickson BS, Stephens RE, Chang JV, et al. Cardiovascular evaluation after COVID-19 in 137 collegiate athletes: results of an algorithm-guided screening. Circulation. 2021;143:1926-1928.