Covid-19 Linked To Heart Damage In Healthy People

September 12, 2020

A small new study suggests that people who recover from COVID-19 may have lingering heart damage and inflammation in the months after the initial infection, even if they aren’t hospitalized.

The study, published Monday (July 27) in the journal JAMA Cardiology, involved 100 German adults aged 45 to 53 who had recently recovered from COVID-19. About one-third of the participants required hospitalization, while the other two-thirds were able to recover at home. On MRI scans performed more than two months after diagnosis, about three-quarters of these patients showed signs of heart abnormalities, including myocardial inflammation or myocarditis. Many of the patients also had levels of a protein called troponin detected in their blood, which can indicate damage to the heart, such as after a heart attack. (According to the University of Rochester Medical Center, troponin is a protein found in heart cells that is released into the bloodstream when the heart muscle is damaged).

However, exactly what these findings mean for patients’ long-term heart health isn’t clear, the authors say. The heart abnormalities seen in the study occasionally occur in conjunction with other respiratory illnesses such as the flu, and may be temporary – in fact, mild cases of heart inflammation may not show symptoms and often get better on their own, according to the National Heart, Lung, and Blood Institute.

But given how common heart abnormalities are in this study group, the findings “urgently need to be confirmed” in the larger population, the authors conclude.

The findings are potentially worrisome because heart inflammation and injury can cause heart failure, a potentially life-threatening condition that occurs when the heart muscle can’t pump enough blood to meet the body’s normal demands.

Both researchers and patients were surprised by the prevalence of these heart abnormalities, and they remained evident for weeks after patients recovered, lead study author Dr. Valentina Pontmann of Frankfurt University Hospital told UPI.

“Although we do not yet have direct evidence of [long-term] consequences, such as the development of heart failure…. It’s likely that within a few years this burden will be enormous,” Puntmann said.

While initially recognized primarily as a lung infection, COVID-19 has now been linked to damage to multiple other organs in the body, including the brain and heart. But many of these complications have been observed in patients who were sick enough to be hospitalized.

Of the 100 patients in the new study, 67 were not hospitalized, and most of these people experienced mild or moderate symptoms. Some patients had underlying conditions, such as high blood pressure, diabetes or asthma, but most did not. Patients were followed up with an MRI scan approximately two to three months after initial diagnosis. At this time, about one-third of patients reported experiencing persistent COVID-19 symptoms, such as shortness of breath and general fatigue. A few patients had palpitations and chest pain after their diagnosis, but none thought they had a heart problem with COVID-19, STAT reported.

The researchers compared the scans of recovered COVID-19 patients with those of people who were similar in age and health status but not infected with COVID-19.

Overall, 78 percent of the recovered COVID-19 patients showed signs of some type of heart abnormality. The most common heart problem was inflammation of the myocardium, or myocarditis, which was present in 60 percent of the patients. Some patients also developed symptoms of pericarditis, the tissue that surrounds the heart. Myocarditis occasionally occurs with influenza, adenovirus and other respiratory viruses, although it is much less common, showing for example in less than 10 percent of cases of influenza, according to a 2012 study in the Journal of Influenza Research and Treatment.

The presence of cardiac abnormalities was not related to the severity of COVID-19 disease or the presence of underlying disease in the study participants.

The authors said, “Our findings suggest that pre-existing cardiovascular [disease] was relatively rare and that participants who mostly recovered at home had frequent cardiac inflammatory involvement after COVID-19.”

Another study, also published Monday in JAMA Cardiology, analyzed autopsies of 39 older adults who died of COVID-19 and found evidence of SARS-CoV-2 (the virus that causes COVID-19) in the heart tissue of 61 percent of the patients.

Dr. Clyde Yancy, a cardiologist at Northwestern University’s Feinberg School of Medicine, and Dr. Gregg Fonarow, a cardiologist at UCLA’s Geffen School of Medicine, said in an editorial for the studies that together raise concerns that the COVID-19 pandemic could spur an increase in heart failure cases.

“We tend to raise a new and very clear concern that the cardiomyopathy [heart muscle disease] and heart failure associated with COVID-19 may evolve as the natural history of this infection becomes clearer,” the editorial said.

The authors of the editorial added that they did not want to “generate additional anxiety,” but called for rigorous studies to confirm or refute the new findings.